=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669005450
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY KINNEAR APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2020
-----------------------------------------------------
Last Update Date | 02/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 269 CULLINS RD
-----------------------------------------------------
City | ROCKWALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75032-7758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-533-5304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4844 RED OAK DR
-----------------------------------------------------
City | ROYSE CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75189-2853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-533-5304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP144897
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------