Provider Demographics
NPI:1760224877
Name:COLLINS, KENDRA
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:COLLINS
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 1:6455 W MARKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-8501
Mailing Address - Country:US
Mailing Address - Phone:317-358-3414
Mailing Address - Fax:317-455-9966
Practice Address - Street 1:6455 W MARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-8501
Practice Address - Country:US
Practice Address - Phone:317-358-3414
Practice Address - Fax:317-455-9966
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22-015908251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health