Provider Demographics
NPI:1780127563
Name:KENDALL, MEGAN ELIZABETH (FNP-BC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:KENDALL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ELIZABETH
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2005 S LAKE PARK RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-4155
Mailing Address - Country:US
Mailing Address - Phone:920-882-9990
Mailing Address - Fax:920-882-9544
Practice Address - Street 1:2005 S LAKE PARK RD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-4155
Practice Address - Country:US
Practice Address - Phone:920-882-9990
Practice Address - Fax:920-882-9544
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22047363LF0000X
WI7822363LF0000X
WI782233213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily