Provider Demographics
NPI:1952642175
Name:KENNEDY, MARIA ELAINE (MPH, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ELAINE
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 KEISLER DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7084
Mailing Address - Country:US
Mailing Address - Phone:919-524-6551
Mailing Address - Fax:844-364-9280
Practice Address - Street 1:401 KEISLER DR STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518
Practice Address - Country:US
Practice Address - Phone:919-524-6551
Practice Address - Fax:844-364-9280
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004141133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered