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General NPI Number Information
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NPI Number | 1033454012
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Entity Type | Organization
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Legal Business Name | RDK PAIN MANAGEMENT LLC
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Dates
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Enumeration Date | 12/03/2012
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 2580 CHARLESTOWN RD
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City | NEW ALBANY
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State | IN
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Zip | 47150-2555
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Country | US
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Telephone | 812-941-8635
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Fax | 812-941-8630
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Provider Business Mailing Address
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Address Line | 2580 CHARLESTOWN RD
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City | NEW ALBANY
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State | IN
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Zip | 47150-2555
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Country | US
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Telephone |
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Fax | 812-941-8630
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Authorized Official
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Title or Position | SOLE MEMBER/OWNER
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Name | RICKEY D. KINZEY
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Credential | D.O.
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Telephone | 812-941-8635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 02000860A
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License Number State | IN
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