Provider Demographics
NPI:1124678867
Name:HAYNES NUGENT, KENDRA C
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:C
Last Name:HAYNES NUGENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 WINDRIVER TRL
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-8714
Mailing Address - Country:US
Mailing Address - Phone:631-553-1210
Mailing Address - Fax:
Practice Address - Street 1:89 WINDRIVER TRL
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-8714
Practice Address - Country:US
Practice Address - Phone:631-553-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-15
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty