Provider Demographics
NPI:1225562556
Name:KENDRICK, KRISTEN BROOKE (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:BROOKE
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W 158TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-7104
Mailing Address - Country:US
Mailing Address - Phone:606-205-1288
Mailing Address - Fax:
Practice Address - Street 1:610 W 158TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-7104
Practice Address - Country:US
Practice Address - Phone:212-544-1880
Practice Address - Fax:212-544-1870
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD048387207Q00000X
MDH0089976207Q00000X
NY311014-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine