Provider Demographics
NPI:1710749734
Name:KNATT, KENDRA (APRN ,)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:KNATT
Suffix:
Gender:F
Credentials:APRN ,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 N HWY 360 APT 421
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-8713
Mailing Address - Country:US
Mailing Address - Phone:337-339-0080
Mailing Address - Fax:
Practice Address - Street 1:2355 N HWY 360 APT 421
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-8713
Practice Address - Country:US
Practice Address - Phone:337-339-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX899074163W00000X
TX1138086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163W00000XNursing Service ProvidersRegistered Nurse