Provider Demographics
NPI:1205347549
Name:WILEY, KENDRA LEA (FNP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:LEA
Last Name:WILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:LEA
Other - Last Name:GUERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:3506 21ST ST STE 507
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1233
Practice Address - Country:US
Practice Address - Phone:806-725-4805
Practice Address - Fax:806-723-7815
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily