Provider Demographics
NPI:1578958054
Name:STILWELL, KENDRA TERRY (DO)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:TERRY
Last Name:STILWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KENDRA
Other - Middle Name:TERRY
Other - Last Name:SWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4102 PINION DR
Mailing Address - Street 2:
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-2502
Mailing Address - Country:US
Mailing Address - Phone:719-333-5140
Mailing Address - Fax:
Practice Address - Street 1:4102 PINION DRIVE
Practice Address - Street 2:10TH MEDICAL GROUP
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840
Practice Address - Country:US
Practice Address - Phone:719-333-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2023-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102205083207R00000X, 207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology