Provider Demographics
NPI:1174045439
Name:KENDRICK, TONYA (APRN)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-4109
Mailing Address - Country:US
Mailing Address - Phone:620-251-4300
Mailing Address - Fax:
Practice Address - Street 1:801 W 8TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-4109
Practice Address - Country:US
Practice Address - Phone:620-251-4300
Practice Address - Fax:620-251-4979
Is Sole Proprietor?:No
Enumeration Date:2017-07-08
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99787363LF0000X
KS13111838092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily