MEDICARE: BONNIE M KENNEDY C.R.N.A.

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	367500000X	Certified Registered Nurse Anesthetist	60662	SC
2	367500000X	Certified Registered Nurse Anesthetist	1753	NC

General Provider Information

NPI Number	:	1922008432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE M KENNEDY C.R.N.A.

Provider Business Mailing Address
First Line	:	6555 BARRIER GEORGEVILLE RD
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-8400
Country	:	US
Telephone Number	:	706-431-1097
Fax Number	:

Provider Business Practice Location Address
First Line	:	8201 HEALTHCARE LOOP
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-7072
Country	:	US
Telephone Number	:	980-302-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	10/27/2021

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