Provider Demographics
NPI:1083091581
Name:MCKENDRICK, KRISTY (LAC)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:MCKENDRICK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2499 S CAPITAL OF TEXAS HWY STE A200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7753
Mailing Address - Country:US
Mailing Address - Phone:512-686-3443
Mailing Address - Fax:512-686-3443
Practice Address - Street 1:2499 S CAPITAL OF TEXAS HWY STE A200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7753
Practice Address - Country:US
Practice Address - Phone:512-686-3443
Practice Address - Fax:512-686-3443
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC 1585171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist