MEDICARE: DONNA LOUISE KENDRICK I

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	37915	TN

General Provider Information

NPI Number	:	1982417283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA LOUISE KENDRICK I

Provider Business Mailing Address
First Line	:	124 HIGHWAY 25E S STE 2
Second Line	:
City	:	TAZEWELL
State	:	TN
Zip	:	37879-3014
Country	:	US
Telephone Number	:	423-626-3020
Fax Number	:	855-883-5111

Provider Business Practice Location Address
First Line	:	240 2ND AVE # 5
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-8822
Country	:	US
Telephone Number	:	423-646-4002
Fax Number	:

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

Provider Enumeration Date	:	01/30/2025
Last Update Date	:	05/11/2026

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