Healthcare Provider Details

I. General information

NPI: 1700380375
Provider Name (Legal Business Name): TINA KINNEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W MARTIN LUTHER KING HWY
MAYSVILLE KY
41056
US

IV. Provider business mailing address

PO BOX 1258
WAYNESBORO TN
38485-1258
US

V. Phone/Fax

Practice location:
  • Phone: 606-375-4817
  • Fax: 606-375-4818
Mailing address:
  • Phone: 931-253-1110
  • Fax: 931-722-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012177
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: