Provider Demographics
NPI:1790871895
Name:ADKISSON, KENDRAL WAYNE (MD)
Entity type:Individual
Prefix:
First Name:KENDRAL
Middle Name:WAYNE
Last Name:ADKISSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:K
Other - Middle Name:WAYNE
Other - Last Name:ADKISSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:291 SWEETEN CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1527
Mailing Address - Country:US
Mailing Address - Phone:828-254-0881
Mailing Address - Fax:828-258-1614
Practice Address - Street 1:291 SWEETEN CREEK ROAD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1527
Practice Address - Country:US
Practice Address - Phone:828-254-0881
Practice Address - Fax:828-258-1614
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-00018207RG0100X
FLME82477207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26083OtherBCBS OF FLORIDA
AL059039702OtherBCBS OF ALABAMA
B336OtherHEALTH OPTIONS
002102707001OtherUNITED HEATLH CARE
100015381OtherRAILROAD MEDICARE
FL261558400Medicaid
8242665OtherCIGNA
AL009957930Medicaid
7192252OtherAETNA
8242665OtherCIGNA
AL059039702OtherBCBS OF ALABAMA
H41806Medicare UPIN