Provider Demographics
NPI:1740682095
Name:HAMMOND, KENDRA
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:HAMMOND
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 1:3 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13680-3161
Mailing Address - Country:US
Mailing Address - Phone:315-388-7703
Mailing Address - Fax:
Practice Address - Street 1:10 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WADDINGTON
Practice Address - State:NY
Practice Address - Zip Code:13694
Practice Address - Country:US
Practice Address - Phone:315-388-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY881146141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist