Provider Demographics
NPI:1659541191
Name:HENDRICKS, KENNETH ALLEN (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALLEN
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PSC 819
Mailing Address - Street 2:BOX 18
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09645-0018
Mailing Address - Country:US
Mailing Address - Phone:314-727-3524
Mailing Address - Fax:314-727-3166
Practice Address - Street 1:PSC 819
Practice Address - Street 2:BOX 18
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09645-0018
Practice Address - Country:US
Practice Address - Phone:314-727-3524
Practice Address - Fax:314-727-3166
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102202300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine