Provider Demographics
NPI:1295235851
Name:FREEMAN, KENDRA CORLEAN
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:CORLEAN
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 FOREST PARK CIR
Mailing Address - Street 2:216
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-7189
Mailing Address - Country:US
Mailing Address - Phone:903-715-6597
Mailing Address - Fax:
Practice Address - Street 1:1516 FOREST PARK CIR APT 216
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-7691
Practice Address - Country:US
Practice Address - Phone:903-715-6597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341784164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse