Provider Demographics
NPI:1598045122
Name:KINSEY, JACQUELINE B (CRNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:B
Last Name:KINSEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W CHELTEN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4414
Mailing Address - Country:US
Mailing Address - Phone:215-848-6700
Mailing Address - Fax:
Practice Address - Street 1:515 W CHELTEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-4414
Practice Address - Country:US
Practice Address - Phone:215-848-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011504363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA363LP2300XMedicaid
PA363LC1500XMedicaid
PA363LA2100XMedicaid
PA363LA2200XMedicaid