Provider Demographics
NPI:1679884449
Name:HENDLEY, KEDRON M (FNP)
Entity Type:Individual
Prefix:
First Name:KEDRON
Middle Name:M
Last Name:HENDLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2293 SUGAR HILL RD STE D
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-7787
Mailing Address - Country:US
Mailing Address - Phone:828-652-8727
Mailing Address - Fax:828-652-8793
Practice Address - Street 1:2293 SUGAR HILL RD STE D
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-7787
Practice Address - Country:US
Practice Address - Phone:828-652-8727
Practice Address - Fax:828-652-8793
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004762363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1679884449Medicaid
NC195487OtherNORTH CAROLINA BOARD OF NURSING
NC2594842OtherINDIVIDUAL MEDICARE NUMBER
NC2594842OtherINDIVIDUAL MEDICARE NUMBER