Provider Demographics
NPI:1972197689
Name:BEERER, KENDALL MARIE
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:MARIE
Last Name:BEERER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:PA
Mailing Address - Zip Code:18039-0156
Mailing Address - Country:US
Mailing Address - Phone:267-371-9311
Mailing Address - Fax:
Practice Address - Street 1:2451 GRANT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1031
Practice Address - Country:US
Practice Address - Phone:215-934-3471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF02210579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily