Healthcare Provider Details

I. General information

NPI: 1598045122
Provider Name (Legal Business Name): JACQUELINE B KINSEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W CHELTEN AVE
PHILADELPHIA PA
19144-4414
US

IV. Provider business mailing address

515 W CHELTEN AVE
PHILADELPHIA PA
19144-4414
US

V. Phone/Fax

Practice location:
  • Phone: 215-848-6700
  • Fax:
Mailing address:
  • Phone: 215-848-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP011504
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: