Provider Demographics
NPI:1841794419
Name:KENDRICK, TYLER KENT (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:KENT
Last Name:KENDRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5502 MARVIN SHIELDS BLVD, GULFPORT, MS
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:39501
Mailing Address - Country:US
Mailing Address - Phone:228-871-4033
Mailing Address - Fax:
Practice Address - Street 1:5502 MARVIN SHIELDS BLVD, GULFPORT, MS
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:39501
Practice Address - Country:US
Practice Address - Phone:228-871-4033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000060986207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program