Healthcare Provider Details

I. General information

NPI: 1295471902
Provider Name (Legal Business Name): TONYA KINNEY RN CASE MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

9040A JACKSON AVE MAMC JBLM
TACOMA WA
98431-0001
US

IV. Provider business mailing address

4808 LAKEMONT DR SE
OLYMPIA WA
98513-4551
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-4326
  • Fax: 253-968-6026
Mailing address:
  • Phone: 360-402-3835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN00130790
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: