Provider Demographics
NPI:1841564895
Name:KENDRICK, JORDAN BLAIRE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:BLAIRE
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:JORDAN
Other - Middle Name:BLAIRE
Other - Last Name:BLAKENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:145 SHAKE RAG RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-6682
Mailing Address - Country:US
Mailing Address - Phone:501-745-7161
Mailing Address - Fax:501-745-8714
Practice Address - Street 1:145 SHAKE RAG RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031
Practice Address - Country:US
Practice Address - Phone:501-745-7161
Practice Address - Fax:501-745-8714
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily