Provider Demographics
NPI:1720520042
Name:KENDRICK, KRISTINA KORON
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:KORON
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 S SLAPPEY BLVD
Mailing Address - Street 2:SUITE A COLONY SQUARE SOUTH
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2699
Mailing Address - Country:US
Mailing Address - Phone:229-430-2700
Mailing Address - Fax:229-430-5145
Practice Address - Street 1:1306 S SLAPPEY BLVD
Practice Address - Street 2:SUITE A COLONY SQUARE SOUTH
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2699
Practice Address - Country:US
Practice Address - Phone:229-430-2700
Practice Address - Fax:229-430-5145
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator