Healthcare Provider Details

I. General information

NPI: 1326952136
Provider Name (Legal Business Name): KENDRICK SISCO NRP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 S JACKSON CIR
INDEPENDENCE MO
64057-1955
US

IV. Provider business mailing address

1006 DOGWOOD DR
RAYMORE MO
64083-9492
US

V. Phone/Fax

Practice location:
  • Phone: 620-510-9053
  • Fax:
Mailing address:
  • Phone: 620-510-9053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: