Healthcare Provider Details

I. General information

NPI: 1467457960
Provider Name (Legal Business Name): RICHARD ERNEST KINSEY R.N., B.C., F.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S MOUNT AUBURN RD SUITE 418
CAPE GIRARDEAU MO
63703-4911
US

IV. Provider business mailing address

1332 PERRYVILLE RD
CAPE GIRARDEAU MO
63701-3808
US

V. Phone/Fax

Practice location:
  • Phone: 573-332-6000
  • Fax:
Mailing address:
  • Phone: 573-335-1830
  • Fax: 573-243-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number107463
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: