Provider Demographics
NPI:1073672077
Name:KENDALL, TIFFANY DONNEA
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:DONNEA
Last Name:KENDALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W 2ND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4055
Mailing Address - Country:US
Mailing Address - Phone:704-854-8399
Mailing Address - Fax:704-854-8410
Practice Address - Street 1:212 W 2ND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4055
Practice Address - Country:US
Practice Address - Phone:704-854-8399
Practice Address - Fax:704-854-8410
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator