Healthcare Provider Details

I. General information

NPI: 1154374478
Provider Name (Legal Business Name): BONNIE KENNEDY APRN, BC, P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 BURNETTE CIR
WAYNESVILLE NC
28786-7520
US

IV. Provider business mailing address

3518 DRAWBRIDGE PKWY
GREENSBORO NC
27410-8432
US

V. Phone/Fax

Practice location:
  • Phone: 336-209-3568
  • Fax: 323-366-2966
Mailing address:
  • Phone: 336-209-3568
  • Fax: 336-540-1095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number090018
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: