Healthcare Provider Details

I. General information

NPI: 1528379617
Provider Name (Legal Business Name): ERIN POWERS KINNEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 VISTA AVE 3RD FLOOR WEST PAVILLION RM 320
SAINT LOUIS MO
63110-2539
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-8780
  • Fax: 314-268-5697
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02006663A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2010019024
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: