Provider Demographics
NPI:1679735575
Name:LONE ELK, KENDRA E (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:E
Last Name:LONE ELK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
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 5011
Mailing Address - Street 2:EAST HIWAY 18 AIRPORT ROAD
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770-5011
Mailing Address - Country:US
Mailing Address - Phone:605-867-1704
Mailing Address - Fax:605-867-2063
Practice Address - Street 1:EAST HIWAY 18 AIRPORT ROAD
Practice Address - Street 2:OST HEALTH ADMINISTRATION
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-5011
Practice Address - Country:US
Practice Address - Phone:605-867-1704
Practice Address - Fax:605-867-2063
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSDRN R026838163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD460439437OtherNPI NUMBER