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General NPI Number Information
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NPI Number | 1205347846
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Entity Type | Individual
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Provider Name | BETHANY KINNEY APRN
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Gender | Female
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 4100 W RAUCH RD
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City | PETERSBURG
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State | MI
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Zip | 49270-9800
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Country | US
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Telephone | 419-343-7072
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Fax |
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Provider Business Mailing Address
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Address Line | 14121 PARKE LONG CT
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City | CHANTILLY
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State | VA
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Zip | 20151-1647
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.021938
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License Number State | OH
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