Provider Demographics
NPI:1396764981
Name:PROCTOR, KENDRA DEANN (RN, CFNP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:DEANN
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:RN, CFNP
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Mailing Address - Street 1:1128 CLARKSVILLE ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6060
Mailing Address - Country:US
Mailing Address - Phone:903-785-4362
Mailing Address - Fax:903-782-9365
Practice Address - Street 1:1128 CLARKSVILLE ST
Practice Address - Street 2:STE. 100
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6060
Practice Address - Country:US
Practice Address - Phone:903-785-4362
Practice Address - Fax:903-782-9365
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX562744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
144831802OtherGROUP TEXAS HEALTH STEPS
TX500021734OtherINDIVIDUAL RAILROAD MC
TX88N512OtherINDIVIDUAL BLUE CROSS
TX112250904Medicaid
TX88N512OtherINDIVIDUAL BLUE CROSS
TXS35894Medicare UPIN