Individual
MR. KENNY CHARLES NALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
628 E 12TH ST, WASHINGTON, NC 27889-3409
(252) 974-9361
(252) 974-9115
Mailing address
628 E 12TH ST, WASHINGTON, NC 27889-3409
(252) 974-9361
(252) 974-9115
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
9901269
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1253W
BCBS
NC
05
—
891253W
—
NC
Enumeration date
12/02/2005
Last updated
01/06/2022
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