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NPI Code Detail

MEDICARE: KENDRA B QUILLEN LCSW

MEDICARE: KENDRA B QUILLEN LCSW
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
11041C0700XClinical Social Worker10256TN

General Provider Information

NPI Number : 1578435749
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDRA B QUILLEN LCSW
Provider Business Mailing Address
First Line : 1167 SPRATLIN PARK DR
Second Line :
City : GRAY
State : TN
Zip : 37615-6205
Country : US
Telephone Number : 423-467-3600
Fax Number : 423-467-3644
Provider Business Practice Location Address
First Line : 208 E UNAKA AVE
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37601-4626
Country : US
Telephone Number : 423-926-0940
Fax Number : 423-926-4202
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2025
Last Update Date : 03/10/2026

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