MEDICARE: KIMBERLY DAWNN 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	347C00000X	Private Vehicle	KNSE1	FL

General Provider Information

NPI Number	:	1548129711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DAWNN KENDRICK

Provider Business Mailing Address
First Line	:	11201 WESLEY LAKE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32220-3741
Country	:	US
Telephone Number	:	773-691-4075
Fax Number	:

Provider Business Practice Location Address
First Line	:	11201 WESLEY LAKE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32220-3741
Country	:	US
Telephone Number	:	773-691-4075
Fax Number	:

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

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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