Provider Demographics
NPI:1518570373
Name:MARIACHER, KENDRA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:MARIE
Last Name:MARIACHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:MARIE
Other - Last Name:KEKICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:111 NEW HAMPSHIRE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-2864
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7676 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5110
Practice Address - Country:US
Practice Address - Phone:440-283-3015
Practice Address - Fax:440-283-3010
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008186RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant