MEDICARE: KENDRA MARLINA MILICENT JOHN

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	163W00000X	Registered Nurse	RN.1694632	CO
2	163W00000X	Registered Nurse	N22473	NY

General Provider Information

NPI Number	:	1902751977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA MARLINA MILICENT JOHN

Provider Business Mailing Address
First Line	:	14327 181ST ST
Second Line	:
City	:	SPRINGFIELD GARDENS
State	:	NY
Zip	:	11413-3218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22121 JAMAICA AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-2015
Country	:	US
Telephone Number	:	718-468-6923
Fax Number	:

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

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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