Provider Demographics
NPI:1760501340
Name:KENDRICK, JENNIFER (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 LOVELY LN
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-3675
Mailing Address - Country:US
Mailing Address - Phone:281-542-9089
Mailing Address - Fax:
Practice Address - Street 1:1314 LOVELY LN
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-3675
Practice Address - Country:US
Practice Address - Phone:281-542-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02352363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ14422Medicare UPIN