Individual
FORREST BRUCE KENNEDY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2080 W ARLINGTON BLVD STE B, GREENVILLE, NC 27834
(252) 752-2140
(252) 689-6502
Mailing address
2080 W ARLINGTON BLVD STE B, GREENVILLE, NC 27834-3770
(252) 752-2140
(252) 689-6502
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
245904
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
106614
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043606940
—
NC
Enumeration date
04/08/2015
Last updated
08/21/2018
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