Provider Demographics
NPI:1750835450
Name:KENDALL, ROBERT (RN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KENDALL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6909 SILVER CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-4211
Mailing Address - Country:US
Mailing Address - Phone:580-678-1513
Mailing Address - Fax:
Practice Address - Street 1:6909 SILVER CREEK CIR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-4211
Practice Address - Country:US
Practice Address - Phone:580-678-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK64481163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse