Healthcare Provider Details

I. General information

NPI: 1396764981
Provider Name (Legal Business Name): KENDRA DEANN PROCTOR RN, CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 CLARKSVILLE ST STE. 100
PARIS TX
75460-6060
US

IV. Provider business mailing address

1128 CLARKSVILLE ST STE. 100
PARIS TX
75460-6060
US

V. Phone/Fax

Practice location:
  • Phone: 903-785-4362
  • Fax: 903-782-9365
Mailing address:
  • Phone: 903-785-4362
  • Fax: 903-782-9365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number562744
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: