Provider Demographics
NPI:1073026191
Name:FOREMAN, KENDRA (NP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:FOREMAN
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 1:970 LAWSHE RD
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-1988
Mailing Address - Country:US
Mailing Address - Phone:619-309-9410
Mailing Address - Fax:951-672-3911
Practice Address - Street 1:8770 CUYAMACA ST
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4373
Practice Address - Country:US
Practice Address - Phone:619-596-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-11
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN274096363LP0808X
AL1-154446363LP0808X
AZ226301363LP0808X
CA95007714363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health