Provider Demographics
NPI:1902812019
Name:KENDRICK, JOHN HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HENRY
Last Name:KENDRICK
Suffix:
Gender:M
Credentials:MD
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 6220
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72766-6220
Mailing Address - Country:US
Mailing Address - Phone:479-927-3100
Mailing Address - Fax:479-927-3131
Practice Address - Street 1:5230 WILLOW CREEK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0876
Practice Address - Country:US
Practice Address - Phone:479-927-3100
Practice Address - Fax:479-927-3131
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5210208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR450521250727640000OtherCHAMPUS/TRICARE
OK100079350BMedicaid
AR105085001Medicaid
AR3904680OtherHEALTHSOURCE - CIGNA
AR12311000000OtherQUALCHOICE
MO202391512Medicaid
AR770045401Medicaid
AR182856OtherHEALTHLINK
AR450521250OtherUNITED HEALTHCARE
AR52839OtherBLUE CROSS/BLUE SHIELD
AR450521250727640000OtherCHAMPUS/TRICARE
AR770045401Medicaid