Basic Information
| Provider Information | |||||||||
| NPI: | 1245966514 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENDRICK | ||||||||
| FirstName: | CARA | ||||||||
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| Credential: | DNP, APRN, CPNP-PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4975 LACROSS RD STE 150 | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294066531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436963923 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1952 LONG GROVE DR STE 202 | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294647579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439712992 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2022 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 26334 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.