Provider Demographics
NPI:1205305307
Name:VARNER, KENDELL DWAYNE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:KENDELL
Middle Name:DWAYNE
Last Name:VARNER
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 10TH RD
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-7241
Mailing Address - Country:US
Mailing Address - Phone:479-936-1700
Mailing Address - Fax:
Practice Address - Street 1:617 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-1564
Practice Address - Country:US
Practice Address - Phone:785-632-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02169363A00000X
ARPA-859363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1158140OtherNCCPA