Provider Demographics
NPI:1639649247
Name:SHIREY, KENDALL LEA (PA-C)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:LEA
Last Name:SHIREY
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 1:201 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-7206
Mailing Address - Country:US
Mailing Address - Phone:682-610-7900
Mailing Address - Fax:
Practice Address - Street 1:700 N PEARL ST STE N208
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-7430
Practice Address - Country:US
Practice Address - Phone:214-999-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant