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Individual
KENDRA L MCNELLYE-MATTOX
Active
Individual
KENDRA L MCNELLYE-MATTOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, DFNP-BC
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP124124
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000487073
BLUE SHIELD
IN
05
—
200491110
—
IN
05
—
83625739
—
NM
01
—
F1104136
AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION #
—
01
—
P00301672
RR MEDICARE
IN
Enumeration date
12/27/2005
Last updated
07/24/2015
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