Provider Demographics
NPI:1396590451
Name:HARTNELL, KENDICE (CPM)
Entity type:Individual
Prefix:
First Name:KENDICE
Middle Name:
Last Name:HARTNELL
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 KINGSTON SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37082-9297
Mailing Address - Country:US
Mailing Address - Phone:262-366-8385
Mailing Address - Fax:
Practice Address - Street 1:1514 KINGSTON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:KINGSTON SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37082-9297
Practice Address - Country:US
Practice Address - Phone:262-366-8385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCPM0000000125176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife