Healthcare Provider Details

I. General information

NPI: 1528136868
Provider Name (Legal Business Name): BRENT L KINSEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

2701 S 70TH ST
LINCOLN NE
68506-2918
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-1113
  • Fax: 319-356-1193
Mailing address:
  • Phone: 402-483-3400
  • Fax: 402-483-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number109358
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number469
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number469
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: