Provider Demographics
NPI:1235655929
Name:MARTIN, KENDRA JUSTINE (CNP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:JUSTINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:JUSTINE
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 RUTLAND ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-5829
Mailing Address - Country:US
Mailing Address - Phone:774-766-9783
Mailing Address - Fax:
Practice Address - Street 1:1620 PRESIDENT AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-7148
Practice Address - Country:US
Practice Address - Phone:508-672-2403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2273583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily