Provider Demographics
NPI:1386183622
Name:KINNEY, THERESA M
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:M
Last Name:KINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 MAIN ST # 61914
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-3359
Mailing Address - Country:US
Mailing Address - Phone:406-880-9838
Mailing Address - Fax:406-831-5424
Practice Address - Street 1:5820 N MONTANA AVE TRLR B1
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-6847
Practice Address - Country:US
Practice Address - Phone:406-880-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT124572363LA2200X, 202D00000X
MTAPRN124572261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care