Provider Demographics
NPI:1659197853
Name:DELPH, KENDRA
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:DELPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CENTER ST APT 210
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-5556
Mailing Address - Country:US
Mailing Address - Phone:317-902-3774
Mailing Address - Fax:
Practice Address - Street 1:704 N STATE ST STE C
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-3616
Practice Address - Country:US
Practice Address - Phone:317-406-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program