MEDICARE: ANDREA L KINSEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1013483080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA L KINSEY

Provider Business Mailing Address
First Line	:	4129 FABULOUS FINCHES AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89084-4810
Country	:	US
Telephone Number	:	702-336-4715
Fax Number	:

Provider Business Practice Location Address
First Line	:	4129 FABULOUS FINCHES AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89084-4810
Country	:	US
Telephone Number	:	702-336-4715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2018
Last Update Date	:	10/17/2018

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Directions to “ ANDREA L KINSEY ” Practice Location

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