Provider Demographics
NPI:1275230609
Name:KENT, KENDRA ELIZABETH MIKATARIAN (NP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:ELIZABETH MIKATARIAN
Last Name:KENT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:ELIZABETH
Other - Last Name:MIKATARIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 RUSSELL RD S
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-3499
Mailing Address - Country:US
Mailing Address - Phone:757-274-6571
Mailing Address - Fax:
Practice Address - Street 1:1700 5TH ST SE STE 101
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4607
Practice Address - Country:US
Practice Address - Phone:253-848-8797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61338308363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care