KENDALL CLEVENGER (NPI# 1154654218) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154654218 |
| Entity Type | Individual |
| Full Name | KENDALL CLEVENGER |
| Credential | PA |
| Practice Address |
510 2nd St Se Pine City MN 55063-1706 |
| Mailing Address |
13709 Bistram Rd Grantsburg WI 54840-7237 |
| Practice Telephone | 3206296721 |
| Mailing Telephone | 7154633816 |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2009-09-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 9635 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
510 2ND ST SE |
| City | PINE CITY |
| State | MN |
| Zip Code | 55063-1706 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437244431 | Pine City Area Clinic | Clinic/Center | 510 2nd St Se, Pine City, MN 55063-1706 | 2006-10-04 |
| 1679998983 | Premier Chiropractic LLC | Chiropractor | 510 2nd St Se, Pine City, MN 55063-1706 | 2014-02-23 |
| 1821413279 | Gretchen Blaufuss Skalicky | Chiropractor | 510 2nd St Se, Pine City, MN 55063-1706 | 2014-02-21 |
| 1891133740 | Jennifer L Johnson | Pharmacist | 510 2nd St Se, Pine City, MN 55063-1706 | 2013-06-12 |
| 1336338433 | Nidhi Gupta | Internal Medicine | 510 2nd St Se, Pine City, MN 55063-1706 | 2007-10-15 |
| 1336239623 | Gerald Tolan | Family Medicine | 510 2nd St Se, Pine City, MN 55063-1706 | 2006-10-15 |
| 1629165725 | Michael B Thompson | Family Medicine | 510 2nd St Se, Pine City, MN 55063-1706 | 2006-10-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861025595 | B&b Guardian Angels Home Care Services, Inc | Home Health | 27680 Beroun Crossing Road, Pine City, MN 55063 | 2020-02-21 |
| 1346684289 | Power Chairs and Scooter Store Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 540 Main St S, Pine City, MN 55063 | 2013-04-22 |
| 1225387327 | Avalon Meridian Behavioral Health | Health Maintenance Organization | 645 3rd Avenue Sw, Pine City, MN 55063 | 2012-09-05 |
| 1629226949 | Community Supports Programming Services LLC | Home Health | 500 3rd Ave Se, Suite 2, Pine City, MN 55063 | 2008-08-28 |
| 1033233788 | Meadow Creek LLC | Substance Abuse Rehabilitation Facility | 17305 Meadow Creek Lane, Pine City, MN 55063 | 2007-03-19 |
| 1477647006 | Rachel E Waxberg | Chiropractor | 805 Main Street South, Pine City, MN 55063 | 2006-10-03 |
| 1306947494 | Joseph Norbert Nilsson | Chiropractor | 253 5th St Se, Pine City, MN 55063 | 2006-09-25 |
| 1851324313 | Pine Eye Associates, Pa | Optometrist | 110 Evergreen Square, Pine City, MN 55063 | 2006-07-08 |
| 1053372656 | Kristie Ann Roberts | Dentist | 1105 Hillside Ave Sw, Pine City, MN 55063 | 2006-03-31 |
| 1114495827 | Kelly Ann Buchta | Social Worker | 220 Railroad St Se, Pine City, MN 55063 | 2018-11-12 |
| Find all providers in zip 55063 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295108421 | Sheryl Elaine Anderson | Physician Assistant | 1425 Main St N, Pine City, MN 55063-6026 | 2015-11-10 |
| 1710118781 | Andrea E Herman | Physician Assistant | 1243 Pennsylvania Ave, Pine City, NY 14871-9230 | 2009-08-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588265284 | Foua Vang | Physician Assistant | 689 County Road D E Apt 302, Saint Paul, MN 55117-1263 | 2020-11-08 |
| 1043811870 | Leiah Hoffman | Physician Assistant | 4243 Timberridge Ln Apt A, Hermantown, MN 55811-4047 | 2020-11-06 |
| 1760083059 | Amanda Hanover | Physician Assistant | 10346 Mississippi Blvd Nw, Coon Rapids, MN 55433-4521 | 2020-11-04 |
| 1780284844 | Lily Ganz | Physician Assistant | 2737 Huntington Ave, St Louis Park, MN 55416-3917 | 2020-10-28 |
| 1972103000 | Jaclyn Ann Bautch | Physician Assistant | 24721 State Highway 15, Saint Augusta, MN 56301-9211 | 2020-10-28 |
| 1801496047 | Tanner Vaughn Kramp | Physician Assistant | 3450 Wild Turkey Rd, Red Wing, MN 55066-1762 | 2020-10-27 |
| 1497354955 | Sarah Marti | Physician Assistant | 810 Thornton St Se Apt 904, Minneapolis, MN 55414-3652 | 2020-10-25 |
| 1598364473 | Kylee N Persing | Physician Assistant | 10 4th Ave S, Saint Cloud, MN 56301-3614 | 2020-10-21 |
| 1073112009 | Reece Edward Mcevoy | Physician Assistant | 2638 Sand Trap Rd Se, Rochester, MN 55904-3904 | 2020-10-21 |
| 1679189021 | Anne Elizabeth Drabot | Physician Assistant | 4741 Vincent Ave S, Minneapolis, MN 55410-1843 | 2020-09-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.