Provider Demographics
NPI:1386205797
Name:ROTEN, KENDRA (NP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:ROTEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 BACKDRAFT TRL
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-4185
Mailing Address - Country:US
Mailing Address - Phone:336-391-2524
Mailing Address - Fax:
Practice Address - Street 1:132 ASHLEY FURNITURE WAY
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006
Practice Address - Country:US
Practice Address - Phone:336-713-8948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF01190172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner