Kendall Ray Haydel, PMH-NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95013912 Issued in CA

Practice address

13700 Marina Pointe Dr Unit 822
Marina del Rey, CA 90292-9263

Phone

(626) 414-6062

Fax

(626) 407-3401

NPI assigned

Feb 11, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714435200000",
    "number": "1316579931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13700 MARINA POINTE DR UNIT 822",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902929263",
            "telephone_number": "337-256-0188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13700 MARINA POINTE DR UNIT 822",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902929263",
            "telephone_number": "626-414-6062",
            "fax_number": "626-407-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYDEL",
        "first_name": "KENDALL",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "credential": "PMH-NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-11",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95013912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.