Provider Demographics
NPI:1609895291
Name:KINNEY, KELLY L (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:L
Last Name:KINNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2150
Mailing Address - Street 2:273 COUNTY ROAD
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-2150
Mailing Address - Country:US
Mailing Address - Phone:603-526-5215
Mailing Address - Fax:603-526-5290
Practice Address - Street 1:273 COUNTY RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5736
Practice Address - Country:US
Practice Address - Phone:603-526-5215
Practice Address - Fax:603-526-5290
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0009599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205606Medicaid
VTP00396189OtherRAILROAD MEDICARE
VT0VN1745Medicaid
VTVN1745Medicare PIN
VTP00396189OtherRAILROAD MEDICARE
D91347Medicare PIN
NH30205606Medicaid
NHRE8524Medicare PIN