Provider Demographics
NPI:1780650192
Name:KINNEY, JANET (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
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 1:1602 DEVON CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4217
Mailing Address - Country:US
Mailing Address - Phone:817-521-3445
Mailing Address - Fax:817-329-1887
Practice Address - Street 1:1679 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3100
Practice Address - Country:US
Practice Address - Phone:817-310-0321
Practice Address - Fax:817-310-0266
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-25
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK32802080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089930407Medicaid
TXD45872Medicare UPIN