Provider Demographics
NPI:1639631096
Name:KENDIG, AMANDA RENEE (CRNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:KENDIG
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8130 ADAMS DR
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-8623
Mailing Address - Country:US
Mailing Address - Phone:717-967-8288
Mailing Address - Fax:717-967-8291
Practice Address - Street 1:300 MAYTOWN RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-9314
Practice Address - Country:US
Practice Address - Phone:717-367-1430
Practice Address - Fax:717-367-2895
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN715836163W00000X
PANPPA037589363L00000X
PASP020363363L00000X
PASP032584363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA836661OtherMEDICARE
PA1036476320001Medicaid