Provider Demographics
NPI:1871361014
Name:KENDALL, CHASITY ANN (CRNP)
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:ANN
Last Name:KENDALL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 GIBLEY PARK RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-2232
Mailing Address - Country:US
Mailing Address - Phone:419-618-4320
Mailing Address - Fax:
Practice Address - Street 1:5308 HARROUN RD STE 55
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2174
Practice Address - Country:US
Practice Address - Phone:419-824-6599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.NP.0034691363L00000X
PASP925010363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner