Provider Demographics
NPI:1376358135
Name:STAFFORD, KENDRA (RN, DNP-FNP STUDENT)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:RN, DNP-FNP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 E 130TH PL S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4437
Mailing Address - Country:US
Mailing Address - Phone:405-464-0910
Mailing Address - Fax:405-464-0910
Practice Address - Street 1:456 E 130TH PL S
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-4437
Practice Address - Country:US
Practice Address - Phone:405-464-0910
Practice Address - Fax:405-464-0910
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program