Provider Demographics
NPI:1043014889
Name:DILLARD, KENEDI JAYNE
Entity type:Individual
Prefix:
First Name:KENEDI
Middle Name:JAYNE
Last Name:DILLARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E 2ND ST STE 11
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5474
Mailing Address - Country:US
Mailing Address - Phone:308-660-1921
Mailing Address - Fax:
Practice Address - Street 1:1015 N ELM ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-2944
Practice Address - Country:US
Practice Address - Phone:308-660-1921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion