Provider Demographics
NPI:1801081658
Name:DEAN, KENDA L (ARNP)
Entity type:Individual
Prefix:
First Name:KENDA
Middle Name:L
Last Name:DEAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KENDA
Other - Middle Name:L
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:GRANDFIELD
Mailing Address - State:OK
Mailing Address - Zip Code:73546-0475
Mailing Address - Country:US
Mailing Address - Phone:580-560-5715
Mailing Address - Fax:580-560-5735
Practice Address - Street 1:117 S BRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:GRANDFIELD
Practice Address - State:OK
Practice Address - Zip Code:73546
Practice Address - Country:US
Practice Address - Phone:580-560-5715
Practice Address - Fax:580-560-5735
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0075098163WG0000X
TXAP133894363LF0000X
OK75098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200125730AMedicaid
OK200125730AMedicaid