Provider Demographics
NPI:1457826232
Name:ROBINSON, KENNDREA (CERTIFIED HAIRLOSS S)
Entity Type:Individual
Prefix:MRS
First Name:KENNDREA
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:CERTIFIED HAIRLOSS S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SOUTHEAST PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-3605
Mailing Address - Country:US
Mailing Address - Phone:817-938-0862
Mailing Address - Fax:
Practice Address - Street 1:1901 SOUTHEAST PKWY STE 106
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-3605
Practice Address - Country:US
Practice Address - Phone:817-919-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14948451744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management