Provider Demographics
NPI:1891924809
Name:NORRIS, KINZIE ADELE (MD)
Entity Type:Individual
Prefix:DR
First Name:KINZIE
Middle Name:ADELE
Last Name:NORRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KINZIE
Other - Middle Name:ADELE
Other - Last Name:MATLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 N 27TH ST
Mailing Address - Street 2:STE 11
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4401
Mailing Address - Country:US
Mailing Address - Phone:405-880-0316
Mailing Address - Fax:402-844-8144
Practice Address - Street 1:301 N 27TH ST
Practice Address - Street 2:SUITE 11
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4401
Practice Address - Country:US
Practice Address - Phone:405-880-0316
Practice Address - Fax:402-844-8122
Is Sole Proprietor?:No
Enumeration Date:2009-07-11
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE298632086X0206X
TXBP10034732-539450390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348449501Medicaid
TX429403YM09Medicare PIN