Provider Demographics
NPI:1558187773
Name:DICKENS, KENDRA AVONA (DS/RN, BSN,MA)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:AVONA
Last Name:DICKENS
Suffix:
Gender:F
Credentials:DS/RN, BSN,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:ARNETT
Mailing Address - State:WV
Mailing Address - Zip Code:25007-0256
Mailing Address - Country:US
Mailing Address - Phone:304-573-7574
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 256
Practice Address - Street 2:
Practice Address - City:ARNETT
Practice Address - State:WV
Practice Address - Zip Code:25007-0256
Practice Address - Country:US
Practice Address - Phone:304-573-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency