Healthcare Provider Details

I. General information

NPI: 1427877349
Provider Name (Legal Business Name): WILLIAM KINSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 FIELD DR
NOBLESVILLE IN
46060-1742
US

IV. Provider business mailing address

1811 CONNER ST
NOBLESVILLE IN
46060-3013
US

V. Phone/Fax

Practice location:
  • Phone: 317-773-0782
  • Fax:
Mailing address:
  • Phone: 317-437-6491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number14725282
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: