Individual
KRYSTAL GLADSON KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1150 E ARLINGTON BLVD, GREENVILLE, NC 27858-5866
(252) 756-1333
(252) 355-2068
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2663
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5013666
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598363681
—
NC
01
—
NNG706B
MEDICARE PTAN
NC
Enumeration date
10/12/2020
Last updated
12/21/2023
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