Provider Demographics
NPI:1558006718
Name:DOWNERYOUNG, KENDRA (RN, MSN)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:DOWNERYOUNG
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 OLYMPIA AVE SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-8138
Mailing Address - Country:US
Mailing Address - Phone:321-914-3068
Mailing Address - Fax:
Practice Address - Street 1:1501 OLYMPIA AVE SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-8138
Practice Address - Country:US
Practice Address - Phone:321-914-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13703310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility