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General NPI Number Information
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NPI Number | 1508676099
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Entity Type | Individual
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Provider Name | KENDELL CANTRELL MATURE PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 22580 HIGHWAY 76 E STE 300
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City | LAURENS
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State | SC
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Zip | 29360-8460
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Country | US
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Telephone | 864-725-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 7310 SAINT LUKES CHURCH RD
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City | PROSPERITY
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State | SC
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Zip | 29127-7125
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MPA.5463
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License Number State | SC
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