Provider Demographics
NPI:1487031480
Name:NICHOLAS, KENDRA (LMP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:DYKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1901 N STATE STREET, SUITE C
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-650-9550
Mailing Address - Fax:360-650-9630
Practice Address - Street 1:1901 N STATE STREET SUITE C
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-650-9550
Practice Address - Fax:360-650-9630
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60383805225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist