Healthcare Provider Details

I. General information

NPI: 1114688082
Provider Name (Legal Business Name): MRS. ALEXANDREA K KINNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 SECOR RD
TOLEDO OH
43623-4299
US

IV. Provider business mailing address

4235 SECOR RD
TOLEDO OH
43623-4299
US

V. Phone/Fax

Practice location:
  • Phone: 877-342-7876
  • Fax: 419-479-5427
Mailing address:
  • Phone: 419-473-3561
  • Fax: 419-479-5593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.008027RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: