Provider Demographics
NPI:1265946024
Name:KENT, AMBER MABE (L AC)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MABE
Last Name:KENT
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 KING EDWARD CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2569
Mailing Address - Country:US
Mailing Address - Phone:336-215-8966
Mailing Address - Fax:
Practice Address - Street 1:4204 KING EDWARD CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2569
Practice Address - Country:US
Practice Address - Phone:336-215-8966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAC-953171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCLAC-953OtherNCALB