Provider Demographics
NPI:1053542720
Name:R. MICHAEL KENNERLY, M.D.,P.A.
Entity type:Organization
Organization Name:R. MICHAEL KENNERLY, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R. MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNERLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-273-9584
Mailing Address - Street 1:PO BOX 2539
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28802-2539
Mailing Address - Country:US
Mailing Address - Phone:828-273-9584
Mailing Address - Fax:
Practice Address - Street 1:1298 CANE CREEK RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-9467
Practice Address - Country:US
Practice Address - Phone:828-273-9584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty