Provider Demographics
NPI:1871334839
Name:GRAY, KENDRA TENESHIA
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:TENESHIA
Last Name:GRAY
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 1:273 MORTON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022-3468
Mailing Address - Country:US
Mailing Address - Phone:269-363-9551
Mailing Address - Fax:
Practice Address - Street 1:273 MORTON AVE APT 1
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-3468
Practice Address - Country:US
Practice Address - Phone:269-363-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula