Provider Demographics
NPI:1588084016
Name:GILLESPIE, KENDRA (MD)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:836 PRUDENTIAL DR STE 1103
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8338
Mailing Address - Country:US
Mailing Address - Phone:904-398-7654
Mailing Address - Fax:904-398-0118
Practice Address - Street 1:836 PRUDENTIAL DR STE 1103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8338
Practice Address - Country:US
Practice Address - Phone:904-398-7654
Practice Address - Fax:904-398-0118
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME135740207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology