Provider Demographics
NPI:1982282372
Name:HALL, KENDRA R (DO)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:R
Last Name:HALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6949 GOOD SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-5204
Mailing Address - Country:US
Mailing Address - Phone:513-931-2400
Mailing Address - Fax:513-931-0132
Practice Address - Street 1:6949 GOOD SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-5204
Practice Address - Country:US
Practice Address - Phone:513-931-2400
Practice Address - Fax:513-931-0132
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.017305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program