Provider Demographics
NPI:1669182705
Name:BARLOW-JOHNSON, KENDRA
Entity type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:
Last Name:BARLOW-JOHNSON
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:PO BOX 10021
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62791-0021
Mailing Address - Country:US
Mailing Address - Phone:217-843-7692
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 10021
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62791-0021
Practice Address - Country:US
Practice Address - Phone:217-843-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2025-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 374K00000X, 174400000X, 251E00000X
WA914078101YP1600X
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No251E00000XAgenciesHome Health
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No376K00000XNursing Service Related ProvidersNurse's Aide