Provider Demographics
NPI:1619578317
Name:MARKLEY, KENDRA DAWN
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:DAWN
Last Name:MARKLEY
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 1:105 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3126
Mailing Address - Country:US
Mailing Address - Phone:304-366-8779
Mailing Address - Fax:
Practice Address - Street 1:105 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3126
Practice Address - Country:US
Practice Address - Phone:304-366-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide