Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MR. KENDERICK RENARD STREET JR. IDC
NPI 1972098184
Military Health Care Provider - Independent Duty Corpsman in Groton, CT

Q: What is Kenderick Street's NPI number?

The NPI number for Kenderick Street is 1972098184. It was assigned to this individual provider in the NPPES registry on June 29, 2018.

Q: What is Kenderick Street's specialty?

The primary specialty registered for this NPI is Military Health Care Provider, specializing in Independent Duty Corpsman, with taxonomy code 1710I1002X.

Q: When was this NPI record last updated?

The NPPES record for Kenderick Street was last updated on September 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 29, 2018

1 WAHOO AVE BLDG 449, GROTON, CT 06349(860) 694-4123 Get Directions Write a Review

NPPES record last updated: September 8, 2026. Verified against the NPPES registry weekly; last sync: September 13, 2026.

Record update history: Sep 8, 2026, Sep 3, 2026, Jun 29, 2018 (3 updates tracked since 2018).

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About Mr. Kenderick Renard Street Jr. Idc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. KENDERICK RENARD STREET JR. IDC (NPI 1972098184) is an individual independent duty corpsman provider in Groton, Connecticut, licensed in Connecticut (1972098184) and active in the NPI registry since June 2018.

NPPES Registry Identity

NPI1972098184

Entity TypeIndividualMale

Primary Taxonomy1710I1002X

Provider Legal NameMR. KENDERICK RENARD STREET JR.Credential: IDC

Location Address1 WAHOO AVE BLDG 449Groton, CT 06349-2324

Mailing Address474 Burningtree DrGroton, CT 06340-3108 · (912) 331-3110

Phone(860) 694-4123

Sole ProprietorNo

Enumeration DateJune 29, 2018

Last NPPES UpdateSeptember 8, 20263 updates tracked since enumeration

NPPES CertifiedSeptember 8, 2026

✔ NPI 1972098184 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyMilitary Health Care Provider · Independent Duty CorpsmanOther Service Providers

Taxonomy Code1710I1002X

License✔ Licensed in CT · 1972098184

Definition

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 other supporting forces such as contractors and foreign nationals.

Also ListedMilitary Health Care ProviderTaxonomy 171000000X · License 1972098184 (CT)

Also ListedTechnician, OtherTaxonomy 247200000X

1 WAHOO AVE BLDG 449, Groton, CT 06349

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Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DANIEL ADAM KILHEFNER SUBIDC

Military Health Care Provider (Independent Duty Corpsman)

1 WAHOO AVE BLDG 449, BOX 600, NAVAL SUBMARINE BASE NEW LONDON
GROTON, CT 06349

Southeastern Connecticut Planning Region (860) 514-1905

DR. JOHN ANTHONY HOYOS DNP, PMHNP-BC

Nurse Practitioner (Psychiatric/Mental Health)