Healthcare Provider Details

I. General information

NPI: 1821696329
Provider Name (Legal Business Name): MONICA RENAE KENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6347 WOOD PARK DR
MEMPHIS TN
38141-7145
US

IV. Provider business mailing address

6347 WOOD PARK DR
MEMPHIS TN
38141-7145
US

V. Phone/Fax

Practice location:
  • Phone: 901-267-2931
  • Fax:
Mailing address:
  • Phone: 901-267-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: