Provider Demographics
NPI:1649926981
Name:LIPSKY, KENDRA LAYNE (NP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:LAYNE
Last Name:LIPSKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:SLATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-1448
Mailing Address - Fax:239-343-4178
Practice Address - Street 1:13340 METRO PKWY STE 310
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4818
Practice Address - Country:US
Practice Address - Phone:239-343-1448
Practice Address - Fax:239-343-4178
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN297906363LA2100X
FLAPRN11024389363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125485000Medicaid