Provider Demographics
NPI:1144025370
Name:BLACKWELL, KENDRA (PMHNP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 VALKRIE PL
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-6625
Mailing Address - Country:US
Mailing Address - Phone:803-417-6325
Mailing Address - Fax:
Practice Address - Street 1:220 13TH AVENUE PL NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2532
Practice Address - Country:US
Practice Address - Phone:828-328-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29971363LP0808X
NC5021664363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health