Healthcare Provider Details

I. General information

NPI: 1235319914
Provider Name (Legal Business Name): BONNIE KENNEDY, APRN, BC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3518 DRAWBRIDGE PKWY
GREENSBORO NC
27410-8432
US

IV. Provider business mailing address

3518 DRAWBRIDGE PKWY
GREENSBORO NC
27410-8432
US

V. Phone/Fax

Practice location:
  • Phone: 336-209-3568
  • Fax: 336-209-3568
Mailing address:
  • Phone: 336-209-3568
  • Fax: 336-209-3568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number090018 (RN)
License Number StateNC

VIII. Authorized Official

Name: BONNIE KENNEDY
Title or Position: PRESIDENT
Credential: MSN,APRN,BC
Phone: 336-209-3568