Provider Demographics
NPI:1609247980
Name:KUYKENDALL, KELSEY
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:KUYKENDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 SW CASCADE AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7126
Mailing Address - Country:US
Mailing Address - Phone:877-755-8940
Mailing Address - Fax:
Practice Address - Street 1:816 ACOMA ST
Practice Address - Street 2:UNIT 1117
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4010
Practice Address - Country:US
Practice Address - Phone:417-262-3204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist