Healthcare Provider Details

I. General information

NPI: 1053227975
Provider Name (Legal Business Name): TAYLOR KENNEDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 WAKE FOREST RD
RALEIGH NC
27609-7317
US

IV. Provider business mailing address

1820 BOWLING GREEN TRL
RALEIGH NC
27613-7469
US

V. Phone/Fax

Practice location:
  • Phone: 919-954-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number320436
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: