Provider Demographics
NPI:1255464665
Name:KINNEY, KAREN DENISE (NP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DENISE
Last Name:KINNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 GREENWOOD TRACE DR
Mailing Address - Street 2:
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-9278
Mailing Address - Country:US
Mailing Address - Phone:317-535-7447
Mailing Address - Fax:
Practice Address - Street 1:503 GREENWOOD TRACE DR
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-9278
Practice Address - Country:US
Practice Address - Phone:317-535-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000537A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200221850Medicaid
IN151560GGGGMedicare PIN
IN151850GGMedicare PIN
IN151560GGGGMedicare PIN