Provider Demographics
NPI:1720627359
Name:HINTON, KENDALL BROOKS
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:BROOKS
Last Name:HINTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:BROOKS
Other - Last Name:MARLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 AVA LN
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-6167
Mailing Address - Country:US
Mailing Address - Phone:870-664-0859
Mailing Address - Fax:
Practice Address - Street 1:1101 AVA LN
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-6167
Practice Address - Country:US
Practice Address - Phone:870-664-0859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program