MEDICARE: JESSICA TRUELOVE KENDRICK PA-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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1932872215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA TRUELOVE KENDRICK PA-C

Provider Business Mailing Address
First Line	:	2179 BAHAMA RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-9543
Country	:	US
Telephone Number	:	859-299-5002
Fax Number	:

Provider Business Practice Location Address
First Line	:	2179 BAHAMA RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-9543
Country	:	US
Telephone Number	:	859-299-5002
Fax Number	:

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

Provider Enumeration Date	:	07/31/2021
Last Update Date	:	10/13/2021

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