Provider Demographics
NPI:1346943271
Name:KINNEY, MATTHEW EDWARD
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:EDWARD
Last Name:KINNEY
Suffix:
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 1:2808 WOODWARD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1265
Mailing Address - Country:US
Mailing Address - Phone:502-889-7090
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR # MA314
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-1702
Practice Address - Country:US
Practice Address - Phone:738-846-0315
Practice Address - Fax:573-884-4205
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025022534207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology