Doctor Name: | KENDRA ROBERTS |
NPI Number: | 1013365006 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | A004736 |
Business Practice Address: | 100 Walco Ln Malvern, AR - 721046793 |
Business Phone Number: | 5014673400 |
Business Fax Number: | |
Mailing Address: | 10107 Suffolk Dr, LITTLE ROCK |
State: | AR |
Postal Code: | 722044247 |
Phone Number: | 5019523962 |
Fax Number: | |
NPI Enumeration Date: | 05/31/2016 |
NPI Last Update Date: | 05/31/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | A004736 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |