Provider Demographics
NPI:1225023799
Name:KINSEY, VICTORIA L (DO)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:L
Last Name:KINSEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:L
Other - Last Name:FOLSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307-0308
Mailing Address - Country:US
Mailing Address - Phone:423-338-8995
Mailing Address - Fax:423-338-8996
Practice Address - Street 1:6784 HIGHWAY 411
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:TN
Practice Address - Zip Code:37307-4818
Practice Address - Country:US
Practice Address - Phone:423-472-2273
Practice Address - Fax:423-472-2737
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2224207Q00000X
MO2001006971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H63289Medicare UPIN
MO268931Medicare ID - Type Unspecified
H63289Medicare UPIN