Provider Demographics
NPI:1639631096
Name:KENDIG, AMANDA RENEE (CRNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:KENDIG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:300 MAYTOWN RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-9314
Practice Address - Country:US
Practice Address - Phone:717-367-1430
Practice Address - Fax:717-367-2895
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN715836163W00000X
PANPPA037589363L00000X
PASP020363363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036476320001Medicaid
PA836661OtherMEDICARE