MEDICARE: KENNEY ORTHOPEDICS OF MONROE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1770142390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNEY ORTHOPEDICS OF MONROE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 650846
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3816 LATROBE DR STE 103
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1373
Country	:	US
Telephone Number	:	704-247-4134
Fax Number	:	704-257-8001

Authorized Official
Title or Position	:	REGULATORY COMPLIANCE ANALYST II
Name	:	GRACE ANGELINE
Credential	:
Telephone Number	:	714-961-2102

Provider Enumeration Date	:	06/07/2019
Last Update Date	:	04/10/2025

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