Provider Demographics
NPI:1629259254
Name:MODELL PARRISH, KENDRA JOY (DO)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:JOY
Last Name:MODELL PARRISH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3513
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702-3513
Mailing Address - Country:US
Mailing Address - Phone:910-272-3048
Mailing Address - Fax:910-738-3764
Practice Address - Street 1:DUKE BREAST CLINIC 2-2
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-2986
Practice Address - Country:US
Practice Address - Phone:919-681-6604
Practice Address - Fax:919-470-3209
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME2276208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1629259254OtherANTHEM
ME1790764512-014Medicaid
ME1790764512-014Medicaid