Provider Demographics
NPI:1689004046
Name:WASZ, KENDALL (PA-C)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:WASZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:
Other - Last Name:HEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1169 EASTERN PKWY STE 2265
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1479
Mailing Address - Country:US
Mailing Address - Phone:502-635-7455
Mailing Address - Fax:502-634-9296
Practice Address - Street 1:4915 NORTON HEALTHCARE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2866
Practice Address - Country:US
Practice Address - Phone:502-635-7455
Practice Address - Fax:502-634-9296
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2365363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPA2365OtherKENTUCKY PHYSICIAN ASSISTANT LICENSE
CAPA23234OtherMED LICENSE