MEDICARE: MRS. KIMBERLY JEAN KINNEY RN, NP

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	363LW0102X	Women's Health Nurse Practitioner	0024164385	VA
2	163W00000X	Registered Nurse	0001151070	VA
3	363LW0102X	Women's Health Nurse Practitioner	RN226089	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04093	OTHER	NC	NC BC/BS
2	10029400N	OTHER	VA	SENTARA/OPTIMA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982679189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY JEAN KINNEY RN, NP

Provider Business Mailing Address
First Line	:	5354 REYNOLDS ST STE 422
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-6011
Country	:	US
Telephone Number	:	912-721-9499
Fax Number	:	912-721-9518

Provider Business Practice Location Address
First Line	:	5354 REYNOLDS ST STE 422
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-6011
Country	:	US
Telephone Number	:	912-721-9499
Fax Number	:	912-721-9518

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	08/19/2013

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