| Doctor Name: | TINA B KENNEDY |
| NPI Number: | 1922125087 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 0050-00700 |
| Business Practice Address: | 119 Crossover Rd Beulaville, NC - 285188801 |
| Business Phone Number: | 9102983125 |
| Business Fax Number: | 9102988101 |
| Mailing Address: | 119 Crossover Rd, BEULAVILLE |
| State: | NC |
| Postal Code: | 285188801 |
| Phone Number: | 9102983125 |
| Fax Number: | 9102988101 |
| NPI Enumeration Date: | 03/23/2007 |
| NPI Last Update Date: | 11/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0050-00700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |