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General NPI Number Information
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NPI Number | 1164748646
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Entity Type | Individual
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Provider Name | TARA M KINNEY CRNA
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Gender | Female
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Dates
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Enumeration Date | 04/09/2010
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 3400 DEXTER CT STE 104
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City | DAVENPORT
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State | IA
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Zip | 52807-3419
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Country | US
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Telephone | 563-334-0234
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Fax | 563-334-0235
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Provider Business Mailing Address
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Address Line | 3400 DEXTER CT STE 104
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City | DAVENPORT
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State | IA
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Zip | 52807-3419
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Country | US
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Telephone | 563-334-0234
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Fax | 563-334-0235
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R1566983
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209009089
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License Number State | IL
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