Provider Demographics
NPI:1790871895
Name:ADKISSON, KENDRAL WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:KENDRAL
Middle Name:WAYNE
Last Name:ADKISSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:K
Other - Middle Name:WAYNE
Other - Last Name:ADKISSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4828 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2341
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-478-2412
Practice Address - Street 1:5147 N 9TH AVE STE 311
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8770
Practice Address - Country:US
Practice Address - Phone:850-477-2597
Practice Address - Fax:850-478-7941
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82477207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
002102707001OtherUNITED HEATLH CARE
B336OtherHEALTH OPTIONS
AL059039702OtherBCBS OF ALABAMA
7192252OtherAETNA
FL261558400Medicaid
AL009957930Medicaid
FL26083OtherBCBS OF FLORIDA
100015381OtherRAILROAD MEDICARE
8242665OtherCIGNA
8242665OtherCIGNA
AL059039702OtherBCBS OF ALABAMA
H41806Medicare UPIN