Healthcare Provider Details

I. General information

NPI: 1952642175
Provider Name (Legal Business Name): MARIA ELAINE KENNEDY MPH, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 KEISLER DR STE 101
CARY NC
27518
US

IV. Provider business mailing address

401 KEISLER DR STE 101
CARY NC
27518-7084
US

V. Phone/Fax

Practice location:
  • Phone: 919-524-6551
  • Fax: 844-364-9280
Mailing address:
  • Phone: 919-524-6551
  • Fax: 844-364-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL004141
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: