Provider Demographics
NPI:1649551045
Name:KEENE, KENDRA BRIANNE (MS, PA-C)
Entity type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:BRIANNE
Last Name:KEENE
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5870 CEYLON ST # C-108
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-6746
Mailing Address - Country:US
Mailing Address - Phone:316-250-5999
Mailing Address - Fax:
Practice Address - Street 1:5870 CEYLON ST # C-108
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-6746
Practice Address - Country:US
Practice Address - Phone:316-250-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003789363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant