Healthcare Provider Details

I. General information

NPI: 1659202125
Provider Name (Legal Business Name): DANIELLE NICOLE RENNEKAMP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AIRPORT RD
KINSTON NC
28501-1604
US

IV. Provider business mailing address

210 TOWNE VILLAGE DR
CARY NC
27513-8910
US

V. Phone/Fax

Practice location:
  • Phone: 252-522-7000
  • Fax:
Mailing address:
  • Phone: 919-348-4483
  • Fax: 919-336-4363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: