Provider Demographics
NPI:1679510325
Name:KENDALL, CONSTANCE CABELL (CRNA)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:CABELL
Last Name:KENDALL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 FAIR RIDGE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:703-295-7669
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:3600 JOSEPH SIEWICK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1709
Practice Address - Country:US
Practice Address - Phone:703-391-3129
Practice Address - Fax:703-391-3006
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024138977367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010252644Medicaid
VA139180OtherANTHEM
VAK142OtherCAREFIRST 2005
VA010252407Medicaid
VA1679510325Medicaid
VA010171253Medicaid
VA484645OtherNCPPO
VAK142OtherCAREFIRST 2005
VA1679510325Medicaid