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NPI Code Detail

MEDICARE: KENDRICK TERRILL CLACK FNP-C

MEDICARE: KENDRICK TERRILL CLACK FNP-C
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
1363LF0000XFamily Nurse PractitionerAP125826TX
2363LF0000XFamily Nurse Practitioner209012875IL

General Provider Information

NPI Number : 1730597659
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDRICK TERRILL CLACK FNP-C
Provider Business Mailing Address
First Line : 3701 KIRBY DR STE 1230
Second Line :
City : HOUSTON
State : TX
Zip : 77098-3916
Country : US
Telephone Number : 713-526-0005
Fax Number :
Provider Business Practice Location Address
First Line : 3701 KIRBY DR STE 1230
Second Line :
City : HOUSTON
State : TX
Zip : 77098-3916
Country : US
Telephone Number : 713-526-0005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2014
Last Update Date : 07/23/2025

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