Healthcare Provider Details

I. General information

NPI: 1609447952
Provider Name (Legal Business Name): HIWET KENDRICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 FREEDOM DR STE 7500
CHARLOTTE NC
28208-3490
US

IV. Provider business mailing address

3205 FREEDOM DR STE 7500
CHARLOTTE NC
28208-3490
US

V. Phone/Fax

Practice location:
  • Phone: 704-336-7130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: