Provider Demographics
NPI:1437638236
Name:KLINE, KENDRA E (FNP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:E
Last Name:KLINE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:E
Other - Last Name:GOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-824-2388
Practice Address - Street 1:100 BROAD ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4349
Practice Address - Country:US
Practice Address - Phone:518-792-2223
Practice Address - Fax:518-792-8231
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343459363LF0000X
NYF343459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily