Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 14314 | AL |
NPI | 1073692232 |
---|---|
Provider Name | Mrs. Patricia Ann Kendrick-Robinson |
First Address | Selma, AL 36701-6702 |
Second Address | Selma, AL 36703-4301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 03/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009909225 | (05) | AL |
51500362 | BCBS (01) | AL |
529913320 | (05) | AL |
D83870 | (02) | AL |