Provider Demographics
NPI:1700864360
Name:KINWORTHY, JANET I (FNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:I
Last Name:KINWORTHY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 PHYSICIANS PARK
Mailing Address - Street 2:SUITE 400
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3956
Mailing Address - Country:US
Mailing Address - Phone:573-727-5500
Mailing Address - Fax:573-686-3441
Practice Address - Street 1:225 PHYSICIANS PARK
Practice Address - Street 2:SUITE 400
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3956
Practice Address - Country:US
Practice Address - Phone:573-727-5500
Practice Address - Fax:573-686-3441
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO820554141Medicare ID - Type UnspecifiedMEDICARE
MOS30872Medicare UPIN