Provider Demographics
NPI:1790159838
Name:KENDALL, TIFFANY JO-ANNE
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:JO-ANNE
Last Name:KENDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 SOUTHLEA DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-3059
Mailing Address - Country:US
Mailing Address - Phone:765-543-7252
Mailing Address - Fax:
Practice Address - Street 1:1104 SOUTHLEA DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-3059
Practice Address - Country:US
Practice Address - Phone:765-543-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-29
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0340281964347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle