Provider Demographics
NPI:1952599029
Name:TODT, KENDREA LEA
Entity Type:Individual
Prefix:MRS
First Name:KENDREA
Middle Name:LEA
Last Name:TODT
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 1:644 HENSON RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-0920
Mailing Address - Country:US
Mailing Address - Phone:423-878-5026
Mailing Address - Fax:
Practice Address - Street 1:644 HENSON RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-0920
Practice Address - Country:US
Practice Address - Phone:423-878-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-13
Last Update Date:2007-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000086690163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse