Provider Demographics
NPI:1003281726
Name:SHEARER, KENDRA (REGISTRED NURSE)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:SHEARER
Suffix:
Gender:F
Credentials:REGISTRED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 CHANNEL PARK SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3825
Mailing Address - Country:US
Mailing Address - Phone:404-423-2370
Mailing Address - Fax:770-573-7308
Practice Address - Street 1:1241 CHANNEL PARK SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3825
Practice Address - Country:US
Practice Address - Phone:404-423-2370
Practice Address - Fax:770-573-7308
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN125762163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care