Provider Demographics
NPI:1205504016
Name:THOMAS, KENDRA R (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2396 BATTLE FOREST DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2629
Mailing Address - Country:US
Mailing Address - Phone:720-472-1452
Mailing Address - Fax:
Practice Address - Street 1:2396 BATTLE FOREST DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2629
Practice Address - Country:US
Practice Address - Phone:720-472-1452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO1399251744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACO139925OtherSPECIALIST