Provider Demographics
NPI:1972880102
Name:MCCARTNEY, KINSEY LOU (PA)
Entity Type:Individual
Prefix:MS
First Name:KINSEY
Middle Name:LOU
Last Name:MCCARTNEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 4TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2324
Mailing Address - Country:US
Mailing Address - Phone:415-353-2311
Mailing Address - Fax:415-353-9060
Practice Address - Street 1:1651 4TH ST FL 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2324
Practice Address - Country:US
Practice Address - Phone:415-353-2311
Practice Address - Fax:415-353-9060
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2036363AM0700X, 363AS0400X
TXPA13498363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4318134OtherBCBS
TN103I972546Medicare PIN