Provider Demographics
NPI:1417139452
Name:KAUFMAN, KENDRA R (PA-C)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:R
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:R
Other - Last Name:BOGAARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:500 W RIVER DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1014
Mailing Address - Country:US
Mailing Address - Phone:563-336-3000
Mailing Address - Fax:563-336-3125
Practice Address - Street 1:2750 11TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5216
Practice Address - Country:US
Practice Address - Phone:563-327-2100
Practice Address - Fax:563-327-2102
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-01
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1598759292Medicaid
IL1598759292Medicaid