| Kenly Medical Associates, Pa | |
|
101 East Second Street Kenly NC 27542-0275 | |
| (919) 284-4025 | |
| (919) 284-5965 |
| Full Name | Kenly Medical Associates, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 101 East Second Street, Kenly, North Carolina |
| Authorized Official Name and Position | Hal B Woodall (OWNER) |
| Authorized Official Contact | 9192844025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenly Medical Associates, Pa 101 E 2nd Street Kenly NC 27542-0275 Ph: (919) 284-4025 | Kenly Medical Associates, Pa 101 East Second Street Kenly NC 27542-0275 Ph: (919) 284-4025 |
| NPI Number | 1518075712 |
|---|---|
| Provider Enumeration Date | 08/28/2006 |
| Last Update Date | 05/05/2015 |
| Medicare PECOS PAC ID | 2567657448 |
|---|---|
| Medicare Enrollment ID | O20101117001110 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518075712 | NPI | - | NPPES |
| 890155K | Medicaid | NC | |
| 0155K | Other | BC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Hal B Woodall |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235179128 PECOS PAC ID: 1052401452 Enrollment ID: I20071224000000 |
| Provider Name | Mary Joyce Beasley Gibson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245668938 PECOS PAC ID: 5597998666 Enrollment ID: I20140428000007 |
| Provider Name | Amanda R Cannon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245632157 PECOS PAC ID: 0749509149 Enrollment ID: I20150506002814 |
| Provider Name | Margaret S Hinnant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841775707 PECOS PAC ID: 9739423260 Enrollment ID: I20181210002233 |
| Provider Name | Stacy E Carlson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568085124 PECOS PAC ID: 1951778729 Enrollment ID: I20221108001071 |
Johnston Family Care Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 N Englewood Dr, Kenly, NC 27542 Phone: 919-284-4149 Fax: 919-284-6008 | |
Johnston Family Care Center-kenly Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 N Englewood Dr, Kenly, NC 27542 Phone: 919-284-4149 Fax: 919-284-6008 |