Provider Demographics
NPI:1487003216
Name:SHIRLEY, KENDALL NILS (MD)
Entity Type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:NILS
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E GREENVILLE ST
Mailing Address - Street 2:STE 2000
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1720
Mailing Address - Country:US
Mailing Address - Phone:864-512-5955
Mailing Address - Fax:864-512-5957
Practice Address - Street 1:2000 E GREENVILLE ST STE 2000
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1720
Practice Address - Country:US
Practice Address - Phone:864-512-5955
Practice Address - Fax:864-512-5957
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39665207Q00000X
SCLL39665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine