Provider Demographics
NPI:1609402700
Name:LANDRUM, KENDAL JANELLE
Entity type:Individual
Prefix:
First Name:KENDAL
Middle Name:JANELLE
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KENDAL LANDRUM
Mailing Address - Street 2:2654 GREEN HILLS DR
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431
Mailing Address - Country:US
Mailing Address - Phone:937-409-5527
Mailing Address - Fax:
Practice Address - Street 1:2654 GREEN HILLS DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-8737
Practice Address - Country:US
Practice Address - Phone:937-409-5527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist