Provider Demographics
NPI:1285283739
Name:COLEMAN, KENDRA DENISE
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:DENISE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KENDRA
Other - Middle Name:DENISE
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:737 S JACKSON ST APT 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2476
Mailing Address - Country:US
Mailing Address - Phone:502-345-0959
Mailing Address - Fax:
Practice Address - Street 1:1935 RIVERS LANDING DR
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-8074
Practice Address - Country:US
Practice Address - Phone:502-345-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-07
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider