MEDICARE: LAUREN BRIANNE KINNIRY

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	163WC3500X	Cardiac Rehabilitation Registered Nurse	28269061A	IN
2	363L00000X	Nurse Practitioner	71017343A	IN

General Provider Information

NPI Number	:	1255210472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN BRIANNE KINNIRY

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11123 PARKVIEW PLAZA DR STE 102
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1707
Country	:	US
Telephone Number	:	260-425-5240
Fax Number	:	260-425-5245

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

Provider Enumeration Date	:	09/01/2025
Last Update Date	:	03/02/2026

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Directions to “ LAUREN BRIANNE KINNIRY ” Practice Location

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