Provider Demographics
NPI:1528262797
Name:NALLS, KENDRA (CNA)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:NALLS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 GREEN RIDGE DR W APT L
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2463
Mailing Address - Country:US
Mailing Address - Phone:317-677-3314
Mailing Address - Fax:
Practice Address - Street 1:734 GREEN RIDGE DR W APT L
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2463
Practice Address - Country:US
Practice Address - Phone:317-677-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN48-01-04-01734376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide