Individual provider · Type 1 NPI

Kenderick Renard Street Jr., IDC

Independent Duty Corpsman · Groton, CT

NPI number 1972098184 Active

Practice location

1 Wahoo Ave Bldg 449
Groton, CT 06349-2324

Call (860) 694-4123 Map

Mailing address

474 Burningtree Dr
Groton, CT 06340-3108

Specialties and licenses

TaxonomyCodeLicense
Military Health Care Provider 171000000X1972098184 (CT)
Independent Duty Corpsman Primary 1710I1002X1972098184 (CT)
Other Technician 247200000XNone listed

Independent Duty Corpsman: A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and othe…

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About NPI 1972098184

Kenderick Renard Street Jr., IDC's National Provider Identifier is 1972098184, issued on Jun 29, 2018. The primary taxonomy on file is Independent Duty Corpsman (1710I1002X), and the practice location is in Groton, CT. The record was last updated on Sep 8, 2026.