Individual
BONNIE SUE KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
876 W FARIS RD, GREENVILLE, SC 29605-4253
(864) 455-5648
Mailing address
876 W FARIS RD, GREENVILLE, SC 29605-4253
(864) 455-5648
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
LL92450
SC
363LF0000X
Family Nurse Practitioner
19511
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP3552
—
SC
Enumeration date
10/21/2015
Last updated
08/09/2024
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