Provider Demographics
NPI:1952994295
Name:KENDRICK, SHELIA VASHON
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:VASHON
Last Name:KENDRICK
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 1:7141 HIGHWAY 45 ALT N
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-9444
Mailing Address - Country:US
Mailing Address - Phone:662-524-4319
Mailing Address - Fax:
Practice Address - Street 1:7141 HIGHWAY 45 ALT N
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-9444
Practice Address - Country:US
Practice Address - Phone:662-524-4319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866290163WD1100X, 163WH0200X, 163WI0500X, 163WM0705X, 163WP0809X, 163WW0000X, 163WX0106X, 251J00000X, 163WG0000X, 163W00000X, 163WC0400X, 163WC1500X, 163WC2100X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
No251J00000XAgenciesNursing Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator