Provider Demographics
NPI:1992379440
Name:KENDRICK, AMANDA (NP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2095 E BIG BEAVER RD STE 375
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2374
Mailing Address - Country:US
Mailing Address - Phone:248-963-1124
Mailing Address - Fax:248-250-9263
Practice Address - Street 1:2095 E BIG BEAVER RD STE 375
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2374
Practice Address - Country:US
Practice Address - Phone:248-963-1124
Practice Address - Fax:248-250-9263
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704304706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily