Individual
BRANDON SCOTT KINNEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 350-8000
Mailing address
PO BOX 603949, CHARLOTTE, NC 28260-3949
(919) 350-0351
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-12303
NC
363AM0700X
Medical Physician Assistant
0010-12303
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225652787
—
NC
Enumeration date
06/01/2020
Last updated
04/27/2023
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