Provider Demographics
NPI:1073905709
Name:RINEY, KEVIN (APRN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:RINEY
Suffix:
Gender:M
Credentials:APRN
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 733119
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3119
Mailing Address - Country:US
Mailing Address - Phone:903-375-3742
Mailing Address - Fax:
Practice Address - Street 1:4215 JOE RAMSEY E BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7852
Practice Address - Country:US
Practice Address - Phone:214-345-7456
Practice Address - Fax:214-345-4152
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127622363LF0000X
OK111115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily