Provider Demographics
NPI:1790087666
Name:WOOD, KENDRA SUE (NP-C)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:SUE
Last Name:WOOD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8301 RAWLES AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-7730
Practice Address - Country:US
Practice Address - Phone:317-532-3999
Practice Address - Fax:317-532-3998
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003488A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201005860Medicaid
INM400039379Medicare PIN
INM400039376Medicare PIN
INM400039377Medicare PIN
IN201005860Medicaid
INM400039380Medicare PIN
INM400039381Medicare PIN
INM400034853Medicare PIN