Kendel Lynn Bormann, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2096 Issued in AK

Practice address

1606 23Rd Ave
Fairbanks, AK 99701-6407

Phone

(907) 455-4567

Fax

(907) 458-1580

NPI assigned

Nov 19, 2010

Last updated

Nov 19, 2010By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1290124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290124800000",
    "number": "1508168733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1606 23RD AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997016407",
            "telephone_number": "907-455-4567",
            "fax_number": "907-458-1580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 23RD AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997016407",
            "telephone_number": "907-455-4567",
            "fax_number": "907-458-1580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORMANN",
        "first_name": "KENDEL",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-19",
        "last_updated": "2010-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "2096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OCCUPATIONAL LICENSE",
            "identifier": "2096",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Physician Assistant in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.