Provider Demographics
NPI:1205430931
Name:HARRELL, KENDRA L (CNA, MEDICAL ASSIST)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:L
Last Name:HARRELL
Suffix:
Gender:F
Credentials:CNA, MEDICAL ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 HOLLINS CT APT 201
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-1747
Mailing Address - Country:US
Mailing Address - Phone:757-869-1546
Mailing Address - Fax:
Practice Address - Street 1:590 HOLLINS CT APT 201
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-1747
Practice Address - Country:US
Practice Address - Phone:757-869-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401151888376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide