1659541191 NPI number — DR. KENNETH ALLEN HENDRICKS D.O.

Table of content: DR. KENNETH ALLEN HENDRICKS D.O. (NPI 1659541191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659541191 NPI number — DR. KENNETH ALLEN HENDRICKS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENDRICKS
Provider First Name:
KENNETH
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659541191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 819
Provider Second Line Business Mailing Address:
BOX 18
Provider Business Mailing Address City Name:
FPO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09645-0018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-727-3524
Provider Business Mailing Address Fax Number:
314-727-3166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PSC 819
Provider Second Line Business Practice Location Address:
BOX 18
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09645-0018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-727-3524
Provider Business Practice Location Address Fax Number:
314-727-3166
Provider Enumeration Date:
03/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0102202300 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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