Provider Demographics
NPI:1538110598
Name:KINNETT, MARSHA E (ANP)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:E
Last Name:KINNETT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-5117
Mailing Address - Country:US
Mailing Address - Phone:229-312-5871
Mailing Address - Fax:229-312-5853
Practice Address - Street 1:910 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2393
Practice Address - Country:US
Practice Address - Phone:229-312-7001
Practice Address - Fax:229-312-7006
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN054127363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health