Individual
JACK KENDRICK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1709 KY ROUTE 321 STE 3, PRESTONSBURG, KY 41653-9097
(606) 886-8546
(606) 886-8548
Mailing address
1709 KY ROUTE 321 STE 3, PRESTONSBURG, KY 41653-9097
(606) 886-8546
(606) 886-8548
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29774
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000229925
ANTHEM BLUE CROSS
KY
01
—
010161400
FEDERAL BLACK LUNG
KY
05
—
64297740
—
KY
01
—
P00047645
PALMETTO GBA
KY
Enumeration date
01/06/2007
Last updated
09/08/2025
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