Provider Demographics
NPI:1952441552
Name:HOUDYSHELL, KENDYL EDMAN (RN)
Entity Type:Individual
Prefix:
First Name:KENDYL
Middle Name:EDMAN
Last Name:HOUDYSHELL
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 1:43154 PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-1731
Mailing Address - Country:US
Mailing Address - Phone:951-927-3478
Mailing Address - Fax:
Practice Address - Street 1:650 N STATE ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-2960
Practice Address - Country:US
Practice Address - Phone:951-791-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN306259163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult