Provider Demographics
NPI:1467206763
Name:WASHBURN, KYNDAL SANFORD
Entity Type:Individual
Prefix:MRS
First Name:KYNDAL
Middle Name:SANFORD
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 DODD RD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:AL
Mailing Address - Zip Code:35952-9035
Mailing Address - Country:US
Mailing Address - Phone:256-706-9865
Mailing Address - Fax:
Practice Address - Street 1:135 DODD RD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:AL
Practice Address - Zip Code:35952-9035
Practice Address - Country:US
Practice Address - Phone:256-706-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-171601163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse