Provider Demographics
NPI:1346637477
Name:KENDRICK, CASANDRA (DO)
Entity Type:Individual
Prefix:
First Name:CASANDRA
Middle Name:
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 1:858 EASTERN BYP
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2512
Mailing Address - Country:US
Mailing Address - Phone:859-626-0072
Mailing Address - Fax:859-626-9684
Practice Address - Street 1:858 EASTERN BYP
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2512
Practice Address - Country:US
Practice Address - Phone:859-626-0072
Practice Address - Fax:859-626-9684
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY04406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program