Healthcare Provider Details

I. General information

NPI: 1376264812
Provider Name (Legal Business Name): NATASHA KENDRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 MERCER ST STE D
PRINCETON WV
24740-3114
US

IV. Provider business mailing address

530 TUGGLE HOLLOW RD
MONTCALM WV
24737
US

V. Phone/Fax

Practice location:
  • Phone: 304-431-2443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: