Provider Demographics
NPI:1871091777
Name:PRIDGEN, KENDRA (ATC)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:PRIDGEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 ARKANSAS AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5516
Mailing Address - Country:US
Mailing Address - Phone:202-329-5733
Mailing Address - Fax:
Practice Address - Street 1:4800 MEADE ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3948
Practice Address - Country:US
Practice Address - Phone:202-794-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer