Provider Demographics
NPI:1053612697
Name:HACKNEY, KENDRA KAY (FNP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:KAY
Last Name:HACKNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5770
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:
Practice Address - Street 1:1644 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-4342
Practice Address - Country:US
Practice Address - Phone:707-839-3068
Practice Address - Fax:707-839-3827
Is Sole Proprietor?:No
Enumeration Date:2010-11-13
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027800363LF0000X
CA95354760163WG0000X
MNF0910261363LF0000X
MNCNP2597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice