Provider Demographics
NPI:1104490788
Name:LAROCK, KENDALL (LM, CPM)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:LAROCK
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 DELAWARE CT APT B
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-8782
Mailing Address - Country:US
Mailing Address - Phone:972-835-3392
Mailing Address - Fax:
Practice Address - Street 1:8105 DELAWARE CT APT B
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-8782
Practice Address - Country:US
Practice Address - Phone:972-835-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99439176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife