MEDICARE: KENDRA LAWRENCE NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	AP133602	TX
2	363LA2100X	Acute Care Nurse Practitioner	AP133602	TX
3	363LA2200X	Adult Health Nurse Practitioner	AP133602	TX
4	363L00000X	Nurse Practitioner	11002506	FL
5	207QA0505X	Adult Medicine Physician	11002506	FL
6	207QG0300X	Geriatric Medicine (Family Medicine) Physician	11002506	FL
7	207R00000X	Internal Medicine Physician	11002506	FL

General Provider Information

NPI Number	:	1114450418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA LAWRENCE NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	495 GRAND BLVD STE 206
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-1897
Country	:	US
Telephone Number	:	888-732-3452
Fax Number	:

Provider Business Practice Location Address
First Line	:	1992 LEWIS TURNER BLVD
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1255
Country	:	US
Telephone Number	:	888-732-3452
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	04/03/2024

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