Healthcare Provider Details

I. General information

NPI: 1386594521
Provider Name (Legal Business Name): KENDRA L CURTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HIDDEN VALLEY DR
JACKSON TN
38305-9583
US

IV. Provider business mailing address

3 HIDDEN VALLEY DR
JACKSON TN
38305-9583
US

V. Phone/Fax

Practice location:
  • Phone: 270-321-9204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1509
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: