Provider Demographics
NPI:1548354400
Name:KENDRICK, JO M (NP)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:M
Last Name:KENDRICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 ALCOA HWY, SUITE 435, BUILDING A
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1511
Mailing Address - Country:US
Mailing Address - Phone:865-305-8888
Mailing Address - Fax:865-305-6180
Practice Address - Street 1:1930 ALCOA HWY SUITE 435 BUILDING A
Practice Address - Street 2:
Practice Address - City:KINOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920
Practice Address - Country:US
Practice Address - Phone:865-305-8888
Practice Address - Fax:865-305-6180
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5503363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ36123Medicare UPIN