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NPI Code Detail

MEDICARE: KENDRA TA RAE DIVENS PMHNP-BC

MEDICARE: KENDRA TA RAE DIVENS PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner5022917NC

General Provider Information

NPI Number : 1053293662
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDRA TA RAE DIVENS PMHNP-BC
Provider Business Mailing Address
First Line : 327 1ST AVE NW
Second Line :
City : HICKORY
State : NC
Zip : 28601-6122
Country : US
Telephone Number : 828-695-5900
Fax Number : 828-695-4256
Provider Business Practice Location Address
First Line : 327 1ST AVE NW
Second Line :
City : HICKORY
State : NC
Zip : 28601-6122
Country : US
Telephone Number : 828-695-5900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2025
Last Update Date : 03/11/2026

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Directions to “ KENDRA TA RAE DIVENS PMHNP-BC” Practice Location

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