Provider Demographics
NPI:1912510819
Name:KENDRICK, KIERRA (AGNP-C)
Entity Type:Individual
Prefix:MISS
First Name:KIERRA
Middle Name:
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 PHILLIPS RD APT 9110
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5399
Mailing Address - Country:US
Mailing Address - Phone:478-396-3748
Mailing Address - Fax:
Practice Address - Street 1:5130 SUNFOREST DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6318
Practice Address - Country:US
Practice Address - Phone:657-237-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008442363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health