Provider Demographics
NPI:1407988082
Name:KENDALL, LONNIE MYRON (NP)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:MYRON
Last Name:KENDALL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 WESTOVER TER
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7128
Mailing Address - Country:US
Mailing Address - Phone:336-373-0611
Mailing Address - Fax:336-373-1589
Practice Address - Street 1:1511 WESTOVER TER
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7128
Practice Address - Country:US
Practice Address - Phone:336-373-0611
Practice Address - Fax:336-373-1589
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24403363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
2595203Medicare ID - Type Unspecified