Healthcare Provider Details

I. General information

NPI: 1285110726
Provider Name (Legal Business Name): COURTNEY GRIZZARD KENDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4510
US

IV. Provider business mailing address

2369 STAPLES MILL RD STE 200
RICHMOND VA
23230-2918
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-8206
  • Fax: 804-320-3102
Mailing address:
  • Phone: 804-285-8206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024176358
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: