Provider Demographics
NPI:1366793176
Name:MCKENDREE, MARY ALYCE (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ALYCE
Last Name:MCKENDREE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ALYCE GRINNELL
Other - Last Name:MCKENDREE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:130 COLLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1007
Mailing Address - Country:US
Mailing Address - Phone:757-388-1310
Mailing Address - Fax:757-388-4012
Practice Address - Street 1:615 S HUGHES BLVD
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4785
Practice Address - Country:US
Practice Address - Phone:252-338-3111
Practice Address - Fax:252-333-3774
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169413363LF0000X
NC5018002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily