Provider Demographics
NPI:1730834177
Name:HILES, KENDRA LEA (BSN)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:LEA
Last Name:HILES
Suffix:
Gender:F
Credentials:BSN
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 368
Mailing Address - Street 2:
Mailing Address - City:BUFFALO LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55314-0368
Mailing Address - Country:US
Mailing Address - Phone:320-833-5364
Mailing Address - Fax:320-833-0134
Practice Address - Street 1:703 W YELLOWSTONE TRL
Practice Address - Street 2:
Practice Address - City:BUFFALO LAKE
Practice Address - State:MN
Practice Address - Zip Code:55314-4200
Practice Address - Country:US
Practice Address - Phone:320-833-5364
Practice Address - Fax:320-833-0134
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1432253163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse