Provider Demographics
NPI:1558026740
Name:TEEPLE, KENDRA L (PARAMEDIC)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:L
Last Name:TEEPLE
Suffix:
Gender:F
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 520434
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:AK
Mailing Address - Zip Code:99652-0434
Mailing Address - Country:US
Mailing Address - Phone:907-354-1243
Mailing Address - Fax:
Practice Address - Street 1:5630 B ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1641
Practice Address - Country:US
Practice Address - Phone:907-441-8559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146L00000X
AK851207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic