Provider Demographics
NPI:1982986675
Name:KENNEDY, MICHAEL ELIZABETH (ANP, AG-ACNP)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ELIZABETH
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:ANP, AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 ARENDELL ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2901
Mailing Address - Country:US
Mailing Address - Phone:252-499-6086
Mailing Address - Fax:
Practice Address - Street 1:3500 ARENDELL ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2901
Practice Address - Country:US
Practice Address - Phone:252-499-6086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005311363L00000X, 363LA2200X, 363LC0200X
NC195524363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine