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General NPI Number Information
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NPI Number | 1497632244
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Entity Type | Individual
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Provider Name | DERRICK JON KINNEY
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Gender | Male
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 7763 S BIRCH RIDGE RD
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City | BRITT
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State | MN
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Zip | 55710-8272
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Country | US
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Telephone | 218-750-9308
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Fax |
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Provider Business Mailing Address
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Address Line | 7763 S BIRCH RIDGE RD
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City | BRITT
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State | MN
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Zip | 55710-8272
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Country | US
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Telephone | 218-750-9308
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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 | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | IR814158
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License Number State | MN
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