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General NPI Number Information
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NPI Number | 1558978296
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Entity Type | Individual
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Provider Name | KENDRA ALEXANDRIA ELDRIDGE PERTUSET PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/27/2020
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Last Update Date | 09/27/2020
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Provider Practice Location Address
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Address Line | 2127 25TH ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-3250
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Country | US
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Telephone | 740-355-6634
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Fax | 740-355-1273
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Provider Business Mailing Address
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Address Line | 1361 ROSEMOUNT RD
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City | PORTSMOUTH
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State | OH
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Zip | 45662-6666
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Country | US
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Telephone | 740-727-3337
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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 | 50.006631
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License Number State | OH
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