MEDICARE: JESSE VIDIC KINSEY RN

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	163W00000X	Registered Nurse	NUR-RN-LIC-38036	MT

General Provider Information

NPI Number	:	1801484357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE VIDIC KINSEY RN

Provider Business Mailing Address
First Line	:	147 CASTLE RIDGE DR
Second Line	:
City	:	LEWISTOWN
State	:	MT
Zip	:	59457-8606
Country	:	US
Telephone Number	:	406-564-5453
Fax Number	:

Provider Business Practice Location Address
First Line	:	147 CASTLE RIDGE DR
Second Line	:
City	:	LEWISTOWN
State	:	MT
Zip	:	59457-8606
Country	:	US
Telephone Number	:	406-564-5453
Fax Number	:

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

Provider Enumeration Date	:	01/08/2021
Last Update Date	:	01/08/2021

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