Provider Demographics
NPI:1871204172
Name:FLEENER, KENDRA (APRN)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:FLEENER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-8955
Mailing Address - Country:US
Mailing Address - Phone:270-775-6060
Mailing Address - Fax:270-775-6010
Practice Address - Street 1:1221 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-8955
Practice Address - Country:US
Practice Address - Phone:270-775-6060
Practice Address - Fax:270-775-6010
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018728363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner