MEDICARE: MS. LESLIE KENDRICK AGACNP-BC

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	363LA2100X	Acute Care Nurse Practitioner	31199	SC

General Provider Information

NPI Number	:	1417824434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLIE KENDRICK AGACNP-BC

Provider Business Mailing Address
First Line	:	505 HALEY CT
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6977
Country	:	US
Telephone Number	:	843-437-1172
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 HALEY CT
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6977
Country	:	US
Telephone Number	:	843-437-1172
Fax Number	:

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

Provider Enumeration Date	:	10/22/2025
Last Update Date	:	10/30/2025

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