MEDICARE: MR. KENNETH CHRISTOPHER FARMER RN, ANP

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	363LA2200X	Adult Health Nurse Practitioner	190386	NC
2	363LA2200X	Adult Health Nurse Practitioner	5004456	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5004456	OTHER	NC	NC LICENSE

General Provider Information

NPI Number	:	1578793725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH CHRISTOPHER FARMER RN, ANP

Provider Business Mailing Address
First Line	:	1328 N LAKE PARK BLVD
Second Line	:
City	:	CAROLINA BEACH
State	:	NC
Zip	:	28428-3935
Country	:	US
Telephone Number	:	910-466-4874
Fax Number	:

Provider Business Practice Location Address
First Line	:	6319A CAROLINA BEACH RD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412-2907
Country	:	US
Telephone Number	:	910-399-8666
Fax Number	:	910-399-8664

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

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	07/21/2022

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