Provider Demographics
NPI:1720113442
Name:KENNY, JULIA ELIZABETH ANNE (FNP)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:ELIZABETH ANNE
Last Name:KENNY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 WATAUGA ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1969
Mailing Address - Country:US
Mailing Address - Phone:919-828-9302
Mailing Address - Fax:
Practice Address - Street 1:509 WATAUGA ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1969
Practice Address - Country:US
Practice Address - Phone:919-828-9302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201309363LF0000X
NC88118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2805348BMedicare UPIN