Provider Demographics
NPI:1235319914
Name:BONNIE KENNEDY, APRN, BC, P.A.
Entity Type:Organization
Organization Name:BONNIE KENNEDY, APRN, BC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,APRN,BC
Authorized Official - Phone:336-209-3568
Mailing Address - Street 1:3518 DRAWBRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8432
Mailing Address - Country:US
Mailing Address - Phone:336-209-3568
Mailing Address - Fax:336-209-3568
Practice Address - Street 1:3518 DRAWBRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8432
Practice Address - Country:US
Practice Address - Phone:336-209-3568
Practice Address - Fax:336-209-3568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC090018 (RN)101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC090018OtherRN LICENSE #
NC2337555Medicare PIN