Provider Demographics
NPI:1871387019
Name:BURGOYNE, KENADEE
Entity type:Individual
Prefix:
First Name:KENADEE
Middle Name:
Last Name:BURGOYNE
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 1:66 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-1450
Mailing Address - Country:US
Mailing Address - Phone:801-860-4798
Mailing Address - Fax:
Practice Address - Street 1:215 5TH ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-4033
Practice Address - Country:US
Practice Address - Phone:801-860-4798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant