Provider Demographics
NPI:1962818344
Name:GERACE, KENDRA ANN (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:ANN
Last Name:GERACE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 ALLISON RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5923
Mailing Address - Country:US
Mailing Address - Phone:843-524-1078
Mailing Address - Fax:
Practice Address - Street 1:2403 ALLISON RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5923
Practice Address - Country:US
Practice Address - Phone:843-524-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19650363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics