Healthcare Provider Details

I. General information

NPI: 1427530971
Provider Name (Legal Business Name): TRACIE KINNEY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 CHESTER BLVD. REID URGENT CARE
RICHMOND IN
47374
US

IV. Provider business mailing address

1100 REID PKWY MEDICAL STAFF SERVICES
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-935-1905
  • Fax: 765-935-1910
Mailing address:
  • Phone: 765-983-3293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008285A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28160004A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: