Provider Demographics
NPI:1851549695
Name:ADKISSON, KENDALL BETH (MD)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:BETH
Last Name:ADKISSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4776 HODGES BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7217
Mailing Address - Country:US
Mailing Address - Phone:904-404-8555
Mailing Address - Fax:
Practice Address - Street 1:4776 HODGES BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-7217
Practice Address - Country:US
Practice Address - Phone:904-404-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9116207N00000X
FLME110325207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology