Provider Demographics
NPI:1720275431
Name:KENT, PATRICIA MARTIN (LPN)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARTIN
Last Name:KENT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 AQUA
Mailing Address - Street 2:PO BOX 1927
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040
Mailing Address - Country:US
Mailing Address - Phone:928-608-4207
Mailing Address - Fax:928-645-5059
Practice Address - Street 1:801 AQUA
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040
Practice Address - Country:US
Practice Address - Phone:928-608-4207
Practice Address - Fax:928-645-5059
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPN035081164W00000X
AZRN145943163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse