Provider Demographics
NPI:1932702511
Name:DARWIN, KINSY MARIE
Entity Type:Individual
Prefix:MISS
First Name:KINSY
Middle Name:MARIE
Last Name:DARWIN
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 1:742 W SUNNY RIVER RD APT 1121
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2867
Mailing Address - Country:US
Mailing Address - Phone:385-309-8744
Mailing Address - Fax:
Practice Address - Street 1:742 W SUNNY RIVER RD APT 1121
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-2867
Practice Address - Country:US
Practice Address - Phone:385-309-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FM174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT111990OtherWORK