Provider Demographics
NPI:1386397859
Name:PAULEY, KENDRA B
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:B
Last Name:PAULEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:B
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13511 UPHAM ST
Mailing Address - Street 2:
Mailing Address - City:QUANTICO
Mailing Address - State:VA
Mailing Address - Zip Code:22134-4208
Mailing Address - Country:US
Mailing Address - Phone:304-993-5258
Mailing Address - Fax:
Practice Address - Street 1:4400 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4444
Practice Address - Country:US
Practice Address - Phone:304-993-5258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program