Provider Demographics
NPI:1407604747
Name:STROUD, KENDRA
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:STROUD
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 1:6844 BARDSTOWN RD UNIT 2340
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3050
Mailing Address - Country:US
Mailing Address - Phone:502-654-5121
Mailing Address - Fax:
Practice Address - Street 1:5801 SHELBY ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1352
Practice Address - Country:US
Practice Address - Phone:502-676-9842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor