Healthcare Provider Details

I. General information

NPI: 1922316124
Provider Name (Legal Business Name): WENDY JEAN KINNEY AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 JEFFORDS ST SUITE B
CLEARWATER FL
33756-3810
US

IV. Provider business mailing address

300 JEFFORDS ST SUITE B
CLEARWATER FL
33756-3810
US

V. Phone/Fax

Practice location:
  • Phone: 727-441-1524
  • Fax: 727-443-4206
Mailing address:
  • Phone: 727-441-1524
  • Fax: 727-443-4206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAA61
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA61
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: