Provider Demographics
NPI:1003315151
Name:KINNE, THOMAS CHARLES II
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:CHARLES
Last Name:KINNE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:AZ
Mailing Address - Zip Code:86022-0491
Mailing Address - Country:US
Mailing Address - Phone:928-925-5992
Mailing Address - Fax:
Practice Address - Street 1:314 ASPEN STREET
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:AZ
Practice Address - Zip Code:86022
Practice Address - Country:US
Practice Address - Phone:928-925-5992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8876774385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care