Provider Demographics
NPI:1629801741
Name:CANNON, KENDRA CHANNEL (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:CHANNEL
Last Name:CANNON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:KENDRA
Other - Middle Name:CHANNEL
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:1704 54TH STREET CT W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5044
Mailing Address - Country:US
Mailing Address - Phone:941-920-9177
Mailing Address - Fax:
Practice Address - Street 1:1704 54TH STREET CT W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5044
Practice Address - Country:US
Practice Address - Phone:941-920-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9533883163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health