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NPI Code Detail

MEDICARE: KELLIANNE KINANE

MEDICARE: KELLIANNE KINANE
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
1363A00000XPhysician AssistantPA2539ME

General Provider Information

NPI Number : 1831810118
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLIANNE KINANE
Provider Business Mailing Address
First Line : 5 CENTRAL MAINE XING
Second Line :
City : GARDINER
State : ME
Zip : 04345-6320
Country : US
Telephone Number : 207-582-6608
Fax Number : 207-582-2258
Provider Business Practice Location Address
First Line : 5 CENTRAL MAINE XING
Second Line :
City : GARDINER
State : ME
Zip : 04345-6320
Country : US
Telephone Number : 207-582-6608
Fax Number : 207-582-2258
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2022
Last Update Date : 12/08/2025

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Directions to “ KELLIANNE KINANE ” Practice Location

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