Provider Demographics
NPI:1811969454
Name:VERHELLE, KENDRA R (MD)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:R
Last Name:VERHELLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-1217
Mailing Address - Country:US
Mailing Address - Phone:903-683-6619
Mailing Address - Fax:903-683-1176
Practice Address - Street 1:163 W 5TH ST
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-1217
Practice Address - Country:US
Practice Address - Phone:903-683-6619
Practice Address - Fax:903-683-1176
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7712207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130802507Medicaid
TX8A9563OtherBCBS
TX8B3973Medicare UPIN
TX8A9563OtherBCBS