Provider Demographics
NPI:1649917469
Name:KENNEDY, KELLY ZORNIG (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ZORNIG
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 ENOREE FARM WAY
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-6259
Mailing Address - Country:US
Mailing Address - Phone:706-424-5633
Mailing Address - Fax:
Practice Address - Street 1:317 SAINT FRANCIS DR STE 250
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3968
Practice Address - Country:US
Practice Address - Phone:864-241-5199
Practice Address - Fax:864-675-8967
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily