Kendra Drisdom

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

112573 Issued in AK

Practice address

20435 Granite Park Cir
Eagle River, AK 99577-8852

Phone

(907) 744-1154

NPI assigned

Aug 4, 2014

Last updated

Dec 21, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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": "1407110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545350400000",
    "number": "1336558303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5981 HALIBUT CT",
            "address_2": "UNIT A",
            "city": "JBER",
            "state": "AK",
            "postal_code": "995063620",
            "telephone_number": "907-782-9284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20435 GRANITE PARK CIR",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995778852",
            "telephone_number": "907-744-1154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRISDOM",
        "first_name": "KENDRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-04",
        "last_updated": "2018-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AK",
            "license": "112573",
            "primary": true
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AK",
            "license": "7099",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dopanine LLC
• Rachael Doyle
• Dr. Eldon Dekay, P.C. (Eagle River Orthodontics)
• Alexandra Kay Draper
• Mallory Driscoll, PA-C
• Jacqueline Duffield
• Elizabeth Claire Dufour, MSCC
• Kathleen Dye, PHARM.D.
• Eagle River Acupuncture LLC. (Eagle River Acupuncture)
• Eagle River Behavioral Health

• Registered Nurse in Eagle River, AK
• Providers in Eagle River, AK by specialty
• Registered Nurse in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; 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.