Individual
MR. ETHAN RAYMOND KENNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
15830 BALLANTYNE MEDICAL PL STE 275, CHARLOTTE, NC 28277-4791
(980) 302-8659
(980) 302-8674
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(980) 302-8659
(980) 302-8674
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-09714
NC
Other
Enumeration date
01/23/2020
Last updated
02/12/2024
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