Provider Demographics
NPI:1043806474
Name:STATEN, KENDRA (NP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:STATEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BALBOA RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759-1536
Mailing Address - Country:US
Mailing Address - Phone:256-651-2978
Mailing Address - Fax:
Practice Address - Street 1:532 MADISON ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4205
Practice Address - Country:US
Practice Address - Phone:256-217-9613
Practice Address - Fax:256-217-9618
Is Sole Proprietor?:No
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-126412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily