Healthcare Provider Details

I. General information

NPI: 1487944146
Provider Name (Legal Business Name): EDWARD VERNON KINNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S POPE LICK RD
LOUISVILLE KY
40299-4708
US

IV. Provider business mailing address

2600 S POPE LICK RD
LOUISVILLE KY
40299-4708
US

V. Phone/Fax

Practice location:
  • Phone: 651-717-5959
  • Fax: 502-261-8212
Mailing address:
  • Phone: 651-717-5959
  • Fax: 502-261-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number24060
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: