Provider Demographics
NPI:1629207931
Name:VINEY, MELVIN KILE JR (APRN-BC)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:KILE
Last Name:VINEY
Suffix:JR
Gender:M
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81073-1622
Mailing Address - Country:US
Mailing Address - Phone:719-523-2125
Mailing Address - Fax:719-523-4290
Practice Address - Street 1:810 W BRAMLEY ST
Practice Address - Street 2:
Practice Address - City:JETMORE
Practice Address - State:KS
Practice Address - Zip Code:67854-9320
Practice Address - Country:US
Practice Address - Phone:620-393-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0993946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily