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General NPI Number Information
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NPI Number | 1932820677
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Entity Type | Individual
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Provider Name | FATINA RENEE KENDALL
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Gender | Female
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 765 E HAMILTON AVE
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City | FLINT
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State | MI
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Zip | 48505-4707
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Country | US
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Telephone | 810-233-5340
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Fax |
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Provider Business Mailing Address
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Address Line | 3094 WILD ORCHID LN
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City | BURTON
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State | MI
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Zip | 48519-1583
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Country | US
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Telephone | 810-250-1106
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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 | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 4704294689
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704294689
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License Number State | MI
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