Provider Demographics
NPI:1164916904
Name:PIMENTA, KENDRA RYAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:RYAN
Last Name:PIMENTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 AQUIDNECK AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-7280
Mailing Address - Country:US
Mailing Address - Phone:401-846-0055
Mailing Address - Fax:401-842-0963
Practice Address - Street 1:850 AQUIDNECK AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7280
Practice Address - Country:US
Practice Address - Phone:401-846-0055
Practice Address - Fax:401-842-0963
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant