| Doctor Name: | KENDRA KAY HACKNEY |
| NPI Number: | 1053612697 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | F0910261 |
| Business Practice Address: | 755 53rd Ave Ne Fridley, MN - 554211240 |
| Business Phone Number: | 7635719361 |
| Business Fax Number: | 7637850720 |
| Mailing Address: | 5606 Irving Ave N, BROOKLYN CENTER |
| State: | MN |
| Postal Code: | 554303075 |
| Phone Number: | 7634320485 |
| Fax Number: | |
| NPI Enumeration Date: | 11/13/2010 |
| NPI Last Update Date: | 11/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F0910261 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |