MEDICARE: KINSEY LEA HANSEN PA

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	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	0010-11666	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0010-11666	OTHER	NC	NC MEDICAL BOARD

General Provider Information

NPI Number	:	1245901628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KINSEY LEA HANSEN PA

Provider Business Mailing Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	367-169-2523
Fax Number	:

Provider Business Practice Location Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-9568
Country	:	US
Telephone Number	:	336-716-9252
Fax Number	:

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

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	01/29/2024

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Directions to “ KINSEY LEA HANSEN PA” Practice Location

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