Active NPI
Kenneth Edward Nunnery, MD
- Family Medicine Physician
- Fort Mill, SC
National Provider Identifier
1083677124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 7482
- Practice address
- 1690 Highway 160 W
Fort Mill, SC 29708-8024 - Phone
- (803) 547-7541
- Fax
- (803) 548-0122
- NPI assigned
- Apr 10, 2006
- Last updated
- Feb 15, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 7482 | SC | Primary |
Addresses
Primary practice location
1690 Highway 160 W
Fort Mill, SC 29708-8024
Mailing address
PO Box 602362
Charlotte, NC 28260-2362
Phone (803) 547-7541
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 074822 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7482 | SC | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360886400000",
"number": "1083677124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 602362",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282602362",
"telephone_number": "803-547-7541",
"fax_number": "803-548-0122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1690 HIGHWAY 160 W",
"city": "FORT MILL",
"state": "SC",
"postal_code": "297088024",
"telephone_number": "803-547-7541",
"fax_number": "803-548-0122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUNNERY",
"first_name": "KENNETH",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-10",
"last_updated": "2013-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "SC",
"license": "7482",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "074822",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Mill, SC
- Novant Health Medical Group, LLC
- Novant Health Medical Group, LLC (Novant Health Bariatric Solutions-Stockbridge)
- Novant Health Prep II LLC (Surgical Specialists of Charlotte, a Novant Health network provider - Fort Mill)
- Novant Health, Inc. (Novant Health Red Ventures Wellness Center)
- Novant Medical Group, Inc. (Novant Health Fort Mill Family Medicine)
- Benjamin Obiaks Nwoke, MD, MBA
- Thomas H O'Reilly
- Heather Obrien, RBT
- Sharon Olang, DO
- Olive Oak Family Services, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.