Provider Demographics
NPI:1295164515
Name:AYERS, KENDALL MERYL (RN, CRNP)
Entity type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:MERYL
Last Name:AYERS
Suffix:
Gender:F
Credentials:RN, CRNP
Other - Prefix:MISS
Other - First Name:KENDALL
Other - Middle Name:MERYL
Other - Last Name:FAVOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E BOULDER ST
Mailing Address - Street 2:SUITE 4N 4145B
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 E BOULDER ST
Practice Address - Street 2:SUITE 4N 4145B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:800-243-3839
Practice Address - Fax:954-851-1840
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAYE104379660363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal