Provider Demographics
NPI:1487639688
Name:KENDON, ALYSHIA MIGNON (CRNA)
Entity Type:Individual
Prefix:
First Name:ALYSHIA
Middle Name:MIGNON
Last Name:KENDON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ALYSHIA
Other - Middle Name:
Other - Last Name:SCHULKERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:1 MEDICAL VILLAGE DRIVE
Mailing Address - Street 2:ST. ELIZABETH HOSPITAL EDGWOOD
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-341-7246
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-341-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3187262367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3487OtherBCBS
FL306191400Medicaid
FL306191400Medicaid