Provider Demographics
NPI:1598381949
Name:KENDRICK, REBECCA SAGEBIEL (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SAGEBIEL
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 CARLIN RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3456
Mailing Address - Country:US
Mailing Address - Phone:817-313-3394
Mailing Address - Fax:
Practice Address - Street 1:322 CARLIN RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-3456
Practice Address - Country:US
Practice Address - Phone:817-313-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily