Provider Demographics
NPI:1629181839
Name:ARMOUR, KENDRA D (PA-C)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:D
Last Name:ARMOUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15080 7TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3865
Mailing Address - Country:US
Mailing Address - Phone:760-243-7330
Mailing Address - Fax:760-243-6900
Practice Address - Street 1:15080 7TH ST STE 6
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3865
Practice Address - Country:US
Practice Address - Phone:760-243-7330
Practice Address - Fax:760-243-6900
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13441363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP09287Medicare UPIN
CA0PA134410Medicare ID - Type Unspecified