Basic Information
| Provider Information | |||||||||
| NPI: | 1710368469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENNEDY-MALONE | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | GNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MALONE | ||||||||
| OtherFirstName: | LORRAINE | ||||||||
| OtherMiddleName: | MARIE | ||||||||
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| OtherCredential: | PH.D | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1701 WESTCHESTER DR | ||||||||
| Address2: | SUITE 850 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272627008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022536 | ||||||||
| FaxNumber: | 3368022534 | ||||||||
| Practice Location | |||||||||
| Address1: | 1208 EASTCHESTER DR | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272653170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368022588 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2015 | ||||||||
| LastUpdateDate: | 06/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 5007683 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.