Provider Demographics
NPI:1437772985
Name:KENT, CHARLES DAVID (APRN)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:KENT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ANNANDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55302-3141
Mailing Address - Country:US
Mailing Address - Phone:651-259-3850
Mailing Address - Fax:
Practice Address - Street 1:400 ANNANDALE BLVD
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:MN
Practice Address - Zip Code:55302-3141
Practice Address - Country:US
Practice Address - Phone:651-259-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7409363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health