Healthcare Provider Details

I. General information

NPI: 1710803689
Provider Name (Legal Business Name): KENDRA WOODRUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDRA CLARK

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 CEDAR GLADES DR STE A
MURFREESBORO TN
37128-3203
US

IV. Provider business mailing address

1207 OLD SALEM RD # 112
MURFREESBORO TN
37129-4917
US

V. Phone/Fax

Practice location:
  • Phone: 615-560-6622
  • Fax:
Mailing address:
  • Phone: 615-491-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: