Provider Demographics
NPI:1184494239
Name:KUYKENDALL, SHARON TAMABINE
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:TAMABINE
Last Name:KUYKENDALL
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:PO BOX 79
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:WY
Mailing Address - Zip Code:82636-0079
Mailing Address - Country:US
Mailing Address - Phone:307-258-5735
Mailing Address - Fax:
Practice Address - Street 1:420 CURTIS ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:WY
Practice Address - Zip Code:82636-8574
Practice Address - Country:US
Practice Address - Phone:307-258-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home