Healthcare Provider Details

I. General information

NPI: 1326757055
Provider Name (Legal Business Name): MALINA EMMA-LYN KINNAIRD AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W CLINCH AVE
KNOXVILLE TN
37916-2219
US

IV. Provider business mailing address

5410 BOULDER WAY
KNOXVILLE TN
37918-9357
US

V. Phone/Fax

Practice location:
  • Phone: 865-521-6005
  • Fax: 865-521-6088
Mailing address:
  • Phone: 865-603-2492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2040
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: