Active NPI
Kendyll Eickelberg, RN
- Registered Nurse
- Winter Park, FL
National Provider Identifier
1952094534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN9569151
- Practice address
- 4311 Long Key LN Apt 19109
Winter Park, FL 32792-6991 - Phone
- (281) 839-4319
- NPI assigned
- May 31, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN9569151 | FL | Primary |
Addresses
Primary practice location
4311 Long Key LN Apt 19109
Winter Park, FL 32792-6991
Mailing address
4311 Long Key LN Apt 19109
Winter Park, FL 32792-6991
Phone (281) 839-4319
Other names 1
- Kendyll Willingham
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN9569151 | FL | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Impower, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Longwood, FL
- NPI 1104910868
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685491200000",
"number": "1952094534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4311 LONG KEY LN APT 19109",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327926991",
"telephone_number": "281-839-4319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4311 LONG KEY LN APT 19109",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327926991",
"telephone_number": "281-839-4319"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EICKELBERG",
"first_name": "KENDYLL",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-05-31",
"last_updated": "2023-05-31",
"certification_date": "2023-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "FL",
"license": "RN9569151",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KENDYLL",
"last_name": "WILLINGHAM",
"credential": "RN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Winter Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.