MEDICARE: DR. KENNETH EDWARD NUNNERY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	7482	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083677124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH EDWARD NUNNERY MD

Provider Business Mailing Address
First Line	:	PO BOX 602362
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2362
Country	:	US
Telephone Number	:	803-547-7541
Fax Number	:	803-548-0122

Provider Business Practice Location Address
First Line	:	1690 HIGHWAY 160 W
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8024
Country	:	US
Telephone Number	:	803-547-7541
Fax Number	:	803-548-0122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	02/15/2013

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