Healthcare Provider Details

I. General information

NPI: 1346812880
Provider Name (Legal Business Name): LESLIE FAYE KENDRICK DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 EXETER ST
MANTEO NC
27954-9400
US

IV. Provider business mailing address

860 OMNI BLVD STE 110
NEWPORT NEWS VA
23606-4430
US

V. Phone/Fax

Practice location:
  • Phone: 252-475-5006
  • Fax:
Mailing address:
  • Phone: 757-223-9794
  • Fax: 757-223-9168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024181639
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5021204
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: