Provider Demographics
NPI:1467069823
Name:KENDRA, ALICIA NICOLE (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:NICOLE
Last Name:KENDRA
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ANNE
Mailing Address - State:IL
Mailing Address - Zip Code:60964-5301
Mailing Address - Country:US
Mailing Address - Phone:708-606-6764
Mailing Address - Fax:
Practice Address - Street 1:UPLIFTEDCARE
Practice Address - Street 2:482 MAIN ST. NW
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914
Practice Address - Country:US
Practice Address - Phone:815-939-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020485363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty