Provider Demographics
NPI:1104315159
Name:BRADY, KENDRA M (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:M
Last Name:BRADY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:MELANESE
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR KENDRA M BRADY
Mailing Address - Street 1:872 W ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32310-6123
Mailing Address - Country:US
Mailing Address - Phone:850-224-2469
Mailing Address - Fax:
Practice Address - Street 1:872 W ORANGE AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32310
Practice Address - Country:US
Practice Address - Phone:850-224-2469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-05
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9328817363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner