Provider Demographics
NPI:1366001398
Name:GORE, KENDRA KAY (CNP-FAMILY)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:KAY
Last Name:GORE
Suffix:
Gender:F
Credentials:CNP-FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 STARLITE DR
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-4944
Mailing Address - Country:US
Mailing Address - Phone:572-200-8805
Mailing Address - Fax:405-200-1071
Practice Address - Street 1:102 STARLITE DR
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-4944
Practice Address - Country:US
Practice Address - Phone:572-200-8805
Practice Address - Fax:405-200-1071
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily