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General NPI Number Information
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NPI Number | 1760673404
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Entity Type | Individual
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Provider Name | LISA MARIE KINSEY FNP
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Gender | Female
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 12647 OLIVE BLVD STE 600
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6346
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Country | US
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Telephone | 800-325-3982
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Fax |
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Provider Business Mailing Address
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Address Line | 4760 CHESNEY MEADOWS DR
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City | STRAWBERRY PLAINS
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State | TN
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Zip | 37871-1673
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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 | 0000012737
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License Number State | TN
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