Provider Demographics
NPI:1518029420
Name:KENDALL, GLORIA KAYE (NP)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:KAYE
Last Name:KENDALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15800 DOOLEY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4219
Mailing Address - Country:US
Mailing Address - Phone:972-239-3849
Mailing Address - Fax:972-934-4969
Practice Address - Street 1:15800 DOOLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4219
Practice Address - Country:US
Practice Address - Phone:972-239-3849
Practice Address - Fax:972-934-4969
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224569363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX224569OtherTX ST BD OF NURSE EXAMIN
TX194321903Medicaid
TX194321901Medicaid
TX194321902Medicaid
TX8K8597Medicare PIN
TX194321901Medicaid
TX194321902Medicaid