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General NPI Number Information
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NPI Number | 1962343210
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Entity Type | Individual
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Provider Name | MARK KINNEY
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Gender | Male
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 4075 PARK AVE
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City | MEMPHIS
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State | TN
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Zip | 38111-7400
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Country | US
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Telephone | 901-579-7833
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Fax |
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Provider Business Mailing Address
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Address Line | 3385 LONE ROCK DR
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City | MEMPHIS
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State | TN
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Zip | 38128-1119
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Country | US
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Telephone | 901-579-7833
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB1485841
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License Number State | TN
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