Provider Demographics
NPI:1326465634
Name:KUYKENDALL, JEFFERY DEAN (LMT)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:DEAN
Last Name:KUYKENDALL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 9TH ST NW STE 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3361
Mailing Address - Country:US
Mailing Address - Phone:202-408-4858
Mailing Address - Fax:202-408-4857
Practice Address - Street 1:1410 9TH ST NW STE 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3361
Practice Address - Country:US
Practice Address - Phone:202-408-4858
Practice Address - Fax:202-408-4857
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT0982173C00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No173C00000XOther Service ProvidersReflexologist