Healthcare Provider Details

I. General information

NPI: 1891915047
Provider Name (Legal Business Name): JUSTIN KINDRICK N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W WILLIAMS ST
APEX NC
27502-1846
US

IV. Provider business mailing address

3801 BARRETT DR
RALEIGH NC
27609-7214
US

V. Phone/Fax

Practice location:
  • Phone: 919-870-8409
  • Fax: 877-622-8953
Mailing address:
  • Phone: 919-870-8409
  • Fax: 877-622-8953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5020737
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5020737
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number143100
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16187
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: