Provider Demographics
NPI:1083267041
Name:AVANT, KENDALYNN ANN (BSHA)
Entity Type:Individual
Prefix:
First Name:KENDALYNN
Middle Name:ANN
Last Name:AVANT
Suffix:
Gender:F
Credentials:BSHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49061 DENTON RD
Mailing Address - Street 2:APT. 103
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111
Mailing Address - Country:US
Mailing Address - Phone:407-548-7718
Mailing Address - Fax:
Practice Address - Street 1:49061 DENTON RD
Practice Address - Street 2:APT. 103
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111
Practice Address - Country:US
Practice Address - Phone:407-548-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health