Provider Demographics
NPI:1225525017
Name:MARTINEZ, KENDRA KELLY (MD, IBCLC)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:KELLY
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD, IBCLC
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:MARIE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 MANNING DRIVE CB #7596
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7596
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DRIVE CB #7596
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7596
Practice Address - Country:US
Practice Address - Phone:984-974-5063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN69028208000000X
390200000X
NC308091208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program