Provider Demographics
NPI:1629030309
Name:WEINERT, KENDALL SIKES (NP)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:SIKES
Last Name:WEINERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:MARIE
Other - Last Name:SIKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:671 HIOAKS RD STE B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4072
Mailing Address - Country:US
Mailing Address - Phone:804-272-5814
Mailing Address - Fax:804-560-0232
Practice Address - Street 1:671 HIOAKS RD STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4072
Practice Address - Country:US
Practice Address - Phone:804-272-5814
Practice Address - Fax:804-560-0232
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010203571Medicaid
VA010203571Medicaid
VA008779R71Medicare ID - Type Unspecified