Provider Demographics
NPI:1558937383
Name:FALKNER, KENTRA VICTORIA
Entity Type:Individual
Prefix:
First Name:KENTRA
Middle Name:VICTORIA
Last Name:FALKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4580 HIGHWAY 4 W
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-7061
Mailing Address - Country:US
Mailing Address - Phone:901-240-7178
Mailing Address - Fax:
Practice Address - Street 1:4580 HIGHWAY 4 W
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-7061
Practice Address - Country:US
Practice Address - Phone:901-240-7178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program