Provider Demographics
NPI:1740474998
Name:NEALON, KENDRAH (MPH, APRN)
Entity type:Individual
Prefix:MRS
First Name:KENDRAH
Middle Name:
Last Name:NEALON
Suffix:
Gender:F
Credentials:MPH, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176
Mailing Address - Country:US
Mailing Address - Phone:617-989-3115
Mailing Address - Fax:617-989-3054
Practice Address - Street 1:1125 TREMONT STREET
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02120
Practice Address - Country:US
Practice Address - Phone:617-989-3115
Practice Address - Fax:617-989-3054
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA268239163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse