Provider Demographics
NPI:1457058224
Name:ANTOINE, KENDRA (BS)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 ENTERPRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-6371
Mailing Address - Country:US
Mailing Address - Phone:337-429-5129
Mailing Address - Fax:337-429-5129
Practice Address - Street 1:1925 ENTERPRISE BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-6371
Practice Address - Country:US
Practice Address - Phone:337-429-5129
Practice Address - Fax:337-429-5129
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator