Provider Demographics
NPI:1225752173
Name:BROWN, KENDRICK KENYON
Entity Type:Individual
Prefix:
First Name:KENDRICK
Middle Name:KENYON
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 LOBDELL BLVD APT 802
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1342
Mailing Address - Country:US
Mailing Address - Phone:225-929-1667
Mailing Address - Fax:
Practice Address - Street 1:2136 LOBDELL BLVD APT 802
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1342
Practice Address - Country:US
Practice Address - Phone:225-929-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA006586456172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver