Provider Demographics
NPI:1164438859
Name:HALL-FRANKS, KENDRA SUE (DO)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:SUE
Last Name:HALL-FRANKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KENDRA
Other - Middle Name:S
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3470 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-1946
Practice Address - Country:US
Practice Address - Phone:863-682-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7976207Q00000X, 207QH0002X
IN02006534A207QH0002X, 207Q00000X
FL0S7976208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264692700Medicaid
FLH43936Medicare UPIN
FL264692700Medicaid
FL01692AMedicare UPIN