Provider Demographics
NPI:1598357642
Name:AGAZIE, KENDRALIA MARSHA (MSN, RN, LGSW)
Entity Type:Individual
Prefix:MRS
First Name:KENDRALIA
Middle Name:MARSHA
Last Name:AGAZIE
Suffix:
Gender:F
Credentials:MSN, RN, LGSW
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6304 WALNUT DR.
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126
Mailing Address - Country:US
Mailing Address - Phone:205-718-1503
Mailing Address - Fax:
Practice Address - Street 1:6304 WALNUT DR.
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126
Practice Address - Country:US
Practice Address - Phone:205-718-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2403G1041C0700X
AL1135712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical