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NPI Code Detail

MEDICARE: JOSIE MAE KENDRICK RDH

MEDICARE: JOSIE MAE KENDRICK RDH
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
1124Q00000XDental Hygienist2024019565MO

General Provider Information

NPI Number : 1154132892
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSIE MAE KENDRICK RDH
Provider Business Mailing Address
First Line : 1800 COMMUNITY
Second Line :
City : CLINTON
State : MO
Zip : 64735-8804
Country : US
Telephone Number : 660-885-8131
Fax Number :
Provider Business Practice Location Address
First Line : 303 N KEENE ST STE 202
Second Line :
City : COLUMBIA
State : MO
Zip : 65201-8052
Country : US
Telephone Number : 844-853-8937
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2025
Last Update Date : 12/15/2025

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