MEDICARE: BARBARA KENDRICK

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	363LF0000X	Family Nurse Practitioner	R813451	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134152424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA KENDRICK

Provider Business Mailing Address
First Line	:	PO BOX 746085
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6085
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:	601-364-2600

Provider Business Practice Location Address
First Line	:	911 ELLIS AVE
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39209-6256
Country	:	US
Telephone Number	:	601-533-7016
Fax Number	:	769-333-9150

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	11/15/2024

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Directions to “ BARBARA KENDRICK ” Practice Location

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