Healthcare Provider Details

I. General information

NPI: 1972880102
Provider Name (Legal Business Name): KINSEY LOU MCCARTNEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 4TH ST FL 2
SAN FRANCISCO CA
94158-2324
US

IV. Provider business mailing address

1651 4TH ST FL 2
SAN FRANCISCO CA
94158-2324
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2311
  • Fax: 415-353-9060
Mailing address:
  • Phone: 415-353-2311
  • Fax: 415-353-9060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22809
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13498
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2036
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2036
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: