MEDICARE: NORTHERN NECK NEPHROLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1366402455	OTHER	VA	DR. KINSEL NPI

General Provider Information

NPI Number	:	1457311748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN NECK NEPHROLOGY PC

Provider Business Mailing Address
First Line	:	86 HARRIS RD
Second Line	:
City	:	KILMARNOCK
State	:	VA
Zip	:	22482-3845
Country	:	US
Telephone Number	:	804-435-2651
Fax Number	:	804-435-2302

Provider Business Practice Location Address
First Line	:	86 HARRIS RD
Second Line	:
City	:	KILMARNOCK
State	:	VA
Zip	:	22482-3845
Country	:	US
Telephone Number	:	804-435-2651
Fax Number	:	804-435-2302

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VICKI A KINSEL
Credential	:	MD
Telephone Number	:	804-435-2651

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	01/20/2014

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