MEDICARE: KENTRA VICTORIA FALKNER

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1558937383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENTRA VICTORIA FALKNER

Provider Business Mailing Address
First Line	:	4580 HIGHWAY 4 W
Second Line	:
City	:	HOLLY SPRINGS
State	:	MS
Zip	:	38635-7061
Country	:	US
Telephone Number	:	901-240-7178
Fax Number	:

Provider Business Practice Location Address
First Line	:	4580 HIGHWAY 4 W
Second Line	:
City	:	HOLLY SPRINGS
State	:	MS
Zip	:	38635-7061
Country	:	US
Telephone Number	:	901-240-7178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2021
Last Update Date	:	06/02/2021

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Directions to “ KENTRA VICTORIA FALKNER ” Practice Location

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