Provider Demographics
NPI:1619159696
Name:PIPKIN, KENDRA (CST)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:
Last Name:PIPKIN
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 CROWNPOINT LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4780
Mailing Address - Country:US
Mailing Address - Phone:817-472-9715
Mailing Address - Fax:817-557-1079
Practice Address - Street 1:507 CROWNPOINT LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4780
Practice Address - Country:US
Practice Address - Phone:817-472-9715
Practice Address - Fax:817-557-1079
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103217172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker