Provider Demographics
NPI:1700137700
Name:PFEIFER, KENDALL LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:LYNN
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 LIGONIER ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1426
Mailing Address - Country:US
Mailing Address - Phone:724-539-9736
Mailing Address - Fax:724-539-2836
Practice Address - Street 1:600 LIGONIER ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1426
Practice Address - Country:US
Practice Address - Phone:724-539-9736
Practice Address - Fax:724-539-2836
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055627363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant