Provider Demographics
NPI:1467457960
Name:KINSEY, RICHARD ERNEST (RN, BC, FNP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ERNEST
Last Name:KINSEY
Suffix:
Gender:M
Credentials:RN, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 PERRYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-3808
Mailing Address - Country:US
Mailing Address - Phone:573-335-1830
Mailing Address - Fax:573-243-4700
Practice Address - Street 1:150 S MOUNT AUBURN RD
Practice Address - Street 2:SUITE 418
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4911
Practice Address - Country:US
Practice Address - Phone:573-332-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107463363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425702305Medicaid
MOP42690Medicare UPIN
MO425702305Medicaid