Healthcare Provider Details

I. General information

NPI: 1659197853
Provider Name (Legal Business Name): KENDRA DELPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 N STATE ST STE C
GREENFIELD IN
46140-3616
US

IV. Provider business mailing address

206 CENTER ST APT 210
GREENFIELD IN
46140-5556
US

V. Phone/Fax

Practice location:
  • Phone: 317-406-8191
  • Fax:
Mailing address:
  • Phone: 317-902-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: