Healthcare Provider Details

I. General information

NPI: 1235655929
Provider Name (Legal Business Name): KENDRA JUSTINE MARTIN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDRA JUSTINE BARRY

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 PRESIDENT AVE
FALL RIVER MA
02720-7148
US

IV. Provider business mailing address

40 RUTLAND ST
NEW BEDFORD MA
02745-5829
US

V. Phone/Fax

Practice location:
  • Phone: 508-672-2403
  • Fax:
Mailing address:
  • Phone: 774-766-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2273583
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: