Provider Demographics
NPI:1891598165
Name:KENNY, BERNADETTE (APRN)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:KENNY
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 GAMBRILL LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7553
Mailing Address - Country:US
Mailing Address - Phone:415-264-4646
Mailing Address - Fax:
Practice Address - Street 1:1200 TWO ISLAND CT
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7418
Practice Address - Country:US
Practice Address - Phone:854-444-7676
Practice Address - Fax:854-999-0549
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30029363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health