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NPI Code Detail

MEDICARE: BETHANY ANN KENNEDY M.D.

MEDICARE: BETHANY ANN KENNEDY M.D.
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
12080P0204XPediatric Emergency Medicine (Pediatrics) Physician95251SC
2208M00000XHospitalist Physician95251SC

General Provider Information

NPI Number : 1598409740
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY ANN KENNEDY M.D.
Provider Business Mailing Address
First Line : 5535 PETTIFORD PL
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-3321
Country : US
Telephone Number : 256-503-4343
Fax Number :
Provider Business Practice Location Address
First Line : 10 MCCLENNAN BANKS DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29401-1164
Country : US
Telephone Number : 843-792-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2022
Last Update Date : 02/25/2026

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