Provider Demographics
NPI:1447558812
Name:KINNEY, MICHELLE LEIGH (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEIGH
Last Name:KINNEY
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LEIGH
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:LINCOLNVILLE CENTER
Mailing Address - State:ME
Mailing Address - Zip Code:04850-0164
Mailing Address - Country:US
Mailing Address - Phone:207-763-4751
Mailing Address - Fax:
Practice Address - Street 1:4 GLEN COVE DR STE 10
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4235
Practice Address - Country:US
Practice Address - Phone:207-301-5970
Practice Address - Fax:207-301-5310
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER039182363LF0000X
MECNP111012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily