Provider Demographics
NPI:1790285856
Name:KENDLE, JAYNE ELLEN (APRN)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:ELLEN
Last Name:KENDLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 OLIVE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-6231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 ELK FORK RD
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:KY
Practice Address - Zip Code:42220-7218
Practice Address - Country:US
Practice Address - Phone:270-265-2574
Practice Address - Fax:270-265-3098
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011747363LP0200X
TN23643363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics