MEDICARE: MS. KENDALL R MAREADY FNP-BC

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	163W00000X	Registered Nurse	227374	NC
2	363LF0000X	Family Nurse Practitioner	5013585	NC

General Provider Information

NPI Number	:	1922613215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KENDALL R MAREADY FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 751069
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1069
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 WH SMITH BLVD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5052
Country	:	US
Telephone Number	:	252-816-5150
Fax Number	:	252-816-5151

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

Provider Enumeration Date	:	09/13/2020
Last Update Date	:	12/16/2025

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