Individual provider Active NPI

Kendra Lawrence, NURSE PRACTITIONER

  • Nurse Practitioner
  • Fort Walton Beach, FL
National Provider Identifier
1114450418
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
11002506 Issued in FL
Practice address
1992 Lewis Turner Blvd
Fort Walton Beach, FL 32547-1255
Phone
(888) 732-3452
NPI assigned
Apr 4, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X AP133602 TX
Acute Care Nurse Practitioner 363LA2100X AP133602 TX
Adult Health Nurse Practitioner 363LA2200X AP133602 TX
Nurse Practitioner 363L00000X 11002506 FL Primary
Adult Medicine Physician 207QA0505X 11002506 FL
Geriatric Medicine (Family Medicine) Physician 207QG0300X 11002506 FL
Internal Medicine Physician 207R00000X 11002506 FL

Addresses

Primary practice location

1992 Lewis Turner Blvd
Fort Walton Beach, FL 32547-1255

Mailing address

495 Grand Blvd Ste 206
Miramar Beach, FL 32550-1897
Phone (888) 732-3452

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251208000712 FL Practitioner - Nurse Practitioner 7012279136 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

400 E Rivulon Blvd
Gilbert, AZ 85297-0096

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11002506FLMDGeriatric Medicine (Family Medicine) Physician
AP133602TXMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tecs FL PA CurrentSince Dec 1, 2025 Accepting new patients

Locations

4875 Cason Cove Dr
Orlando, FL 32811
Phone (386) 344-1538

18312 Middlebelt Rd
Livonia, MI 48152
Phone (248) 426-9944

Interoperability endpoints

  • Direct secure messaging: kendra.lawrence.p1@direct.alegiscare.nextgenshare.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1114450418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 GRAND BLVD STE 206",
            "city": "MIRAMAR BEACH",
            "state": "FL",
            "postal_code": "325501897",
            "telephone_number": "888-732-3452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1992 LEWIS TURNER BLVD",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471255",
            "telephone_number": "888-732-3452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWRENCE",
        "first_name": "KENDRA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-04",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "AP133602",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP133602",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "AP133602",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "11002506",
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "FL",
            "license": "11002506",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "FL",
            "license": "11002506",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "11002506",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

Verify at the official NPI Registry.