Provider Demographics
NPI:1659798056
Name:MASON, KENDRA LYNN (PA)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:LYNN
Last Name:MASON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:LYNN
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:615-329-2294
Mailing Address - Fax:615-695-1494
Practice Address - Street 1:8 CITY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-2560
Practice Address - Country:US
Practice Address - Phone:615-329-6600
Practice Address - Fax:615-321-6226
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC009363AM0700X, 363AS0400X, 363A00000X
TN5575363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical