Provider Demographics
NPI:1679351753
Name:KINELL, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:KINELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 P ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3630
Mailing Address - Country:US
Mailing Address - Phone:402-477-0724
Mailing Address - Fax:402-477-0725
Practice Address - Street 1:2000 P ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3630
Practice Address - Country:US
Practice Address - Phone:402-477-0724
Practice Address - Fax:402-477-0725
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist