Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Ethan Raymond Kenney, PHYSICIANASSISTANT

Individual provider Physician Assistant · NPI 1346870821

Mr. Ethan Raymond Kenney, PHYSICIANASSISTANT is a Physician Assistant in Charlotte, North Carolina. Qualified in 2019, 7 years ago. Practices with Novant Health Medical Group, LLC, a 2,410-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
7
Licensed in
NC
In the registry since
2020
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Practice location Address checks out

15830 Ballantyne Medical Pl Ste 275
Charlotte, NC 28277-4791
Phone: (980) 302-8659
Fax: (980) 302-8674
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 330 Billingsley Rd Ste 202, Charlotte, NC 28211-5020 — (704) 316-3070
  • 2801 Randolph Rd Ste 100, Charlotte, NC 28211-1051 — (704) 367-4800
  • 1640 E Roosevelt Blvd, Monroe, NC 28112-4017 — (704) 226-0500

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-09714 (NC)

Record details

NPI number1346870821
Entity typeIndividual (Type 1)
GenderMale
Credentials PHYSICIANASSISTANT
Sole proprietorNo
NPI enumeratedJanuary 23, 2020
Last updated in NPPESFebruary 12, 2024
Certification dateFebruary 12, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Novant Health Medical Group, Llc — 2410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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