Provider Demographics
NPI:1952575565
Name:BARRY, KENDRA KATHLEEN MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:KATHLEEN MARTIN
Last Name:BARRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-339-7551
Mailing Address - Fax:
Practice Address - Street 1:2821 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4137
Practice Address - Country:US
Practice Address - Phone:336-718-3960
Practice Address - Fax:336-718-3998
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-00178208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918090Medicaid