Provider Demographics
NPI:1982417283
Name:KENDRICK, DONNA LOUISE I
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LOUISE
Last Name:KENDRICK
Suffix:I
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 1:1241 VOLUNTEER PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-4632
Mailing Address - Country:US
Mailing Address - Phone:423-530-3703
Mailing Address - Fax:423-500-7352
Practice Address - Street 1:1241 VOLUNTEER PKWY STE 110
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4632
Practice Address - Country:US
Practice Address - Phone:423-530-3703
Practice Address - Fax:423-500-7352
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14319017363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health