Provider Demographics
NPI:1487915492
Name:COGGINS, KENDRA TAMAR (CNA)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:TAMAR
Last Name:COGGINS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 UNIVERSITY DR APT 14C
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3473
Mailing Address - Country:US
Mailing Address - Phone:614-439-1760
Mailing Address - Fax:
Practice Address - Street 1:4800 UNIVERSITY DR APT 14C
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3473
Practice Address - Country:US
Practice Address - Phone:614-439-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
32903372600000X, 374U00000X
NC32903376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide