Provider Demographics
NPI:1780241679
Name:TAN, KENDRA WALKER (MD)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:WALKER
Last Name:TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:MONTAYNE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR DEPT INTERNAL
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-467-2000
Mailing Address - Fax:319-384-8955
Practice Address - Street 1:2060 BRIARGATE PKWY STE 150
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7660
Practice Address - Country:US
Practice Address - Phone:719-471-1763
Practice Address - Fax:719-471-2498
Is Sole Proprietor?:No
Enumeration Date:2019-05-25
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0073399207ND0101X
IAMD-49793207N00000X
MOMD-49793207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology