Provider Demographics
NPI:1184116816
Name:LEVI, KENDRA N (DO)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:N
Last Name:LEVI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:L
Other - Last Name:NEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:502 BULLOCKS POINT AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-3504
Mailing Address - Country:US
Mailing Address - Phone:401-919-7421
Mailing Address - Fax:949-695-2049
Practice Address - Street 1:502 BULLOCKS POINT AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915
Practice Address - Country:US
Practice Address - Phone:401-919-7421
Practice Address - Fax:949-695-2049
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT69064207Q00000X, 207Q00000X
RIDO01178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine