Provider Demographics
NPI:1194383075
Name:KINNETT, WILLIAM JORDAN (MSN, APRN, ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JORDAN
Last Name:KINNETT
Suffix:
Gender:M
Credentials:MSN, APRN, ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-4245
Mailing Address - Country:US
Mailing Address - Phone:229-273-0359
Mailing Address - Fax:229-273-0360
Practice Address - Street 1:110 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-4245
Practice Address - Country:US
Practice Address - Phone:229-273-0359
Practice Address - Fax:229-273-0360
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207403163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse