Provider Demographics
NPI:1518214253
Name:DODIE LYNN KIRKENDOLL
Entity Type:Organization
Organization Name:DODIE LYNN KIRKENDOLL
Other - Org Name:ADVANCED FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DODIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIRKENDOLL
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:270-316-1063
Mailing Address - Street 1:2315 MAYFAIR DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4557
Mailing Address - Country:US
Mailing Address - Phone:270-316-1063
Mailing Address - Fax:
Practice Address - Street 1:2315 MAYFAIR DR
Practice Address - Street 2:SUITE 9
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4557
Practice Address - Country:US
Practice Address - Phone:270-316-1063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty