Healthcare Provider Details

I. General information

NPI: 1114953718
Provider Name (Legal Business Name): BEVERLY H KINNE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 MOUNTAIN VIEW RD
COPAKE NY
12516-1239
US

IV. Provider business mailing address

PO BOX 2000
HUDSON NY
12534-2000
US

V. Phone/Fax

Practice location:
  • Phone: 518-392-3900
  • Fax: 518-392-1040
Mailing address:
  • Phone: 518-828-8363
  • Fax: 518-697-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF302098
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number360033
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: