Healthcare Provider Details

I. General information

NPI: 1588594964
Provider Name (Legal Business Name): KENNETH CARROLL MEE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 GLENWOOD AVE STE 200
RALEIGH NC
27612-3857
US

IV. Provider business mailing address

11221 AVOCET LN APT 100
RALEIGH NC
27617-8468
US

V. Phone/Fax

Practice location:
  • Phone: 919-457-6016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2024761901
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: