Provider Demographics
NPI:1225388929
Name:PATRICK, KENDRA PAUL (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:PAUL
Last Name:PATRICK
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:KENDRA
Other - Middle Name:PAUL
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:3009 RAY WEILAND DR UNIT 122
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-3251
Mailing Address - Country:US
Mailing Address - Phone:225-454-3744
Mailing Address - Fax:915-296-5612
Practice Address - Street 1:4911 GROOM RD
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-3145
Practice Address - Country:US
Practice Address - Phone:225-454-3744
Practice Address - Fax:915-296-5612
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07070363LF0000X, 363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA277469YP13OtherMEDICARE PTAN
LA2324918Medicaid