Provider Demographics
NPI:1730301292
Name:WILLE, KENDEL (PA)
Entity Type:Individual
Prefix:
First Name:KENDEL
Middle Name:
Last Name:WILLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:8608 IPSWICH BAY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-2742
Mailing Address - Country:US
Mailing Address - Phone:512-440-1113
Mailing Address - Fax:512-444-1346
Practice Address - Street 1:4007 JAMES CASEY
Practice Address - Street 2:SUITE B220
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-440-1113
Practice Address - Fax:512-444-1346
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA05115363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant