Provider Demographics
NPI:1043261381
Name:CHURCH, KENDRA LYNNE (MS PA C)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:LYNNE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:MS PA C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:17 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180
Mailing Address - Country:US
Mailing Address - Phone:617-921-8072
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY STREET
Practice Address - Street 2:D1 B30
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6084
Practice Address - Country:US
Practice Address - Phone:617-525-7486
Practice Address - Fax:617-278-6965
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1388363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant