Provider Demographics
NPI:1982679189
Name:KINNEY, KIMBERLY JEAN (RN, NP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:KINNEY
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5354 REYNOLDS ST STE 422
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6011
Mailing Address - Country:US
Mailing Address - Phone:912-721-9499
Mailing Address - Fax:912-721-9518
Practice Address - Street 1:5354 REYNOLDS ST STE 422
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6011
Practice Address - Country:US
Practice Address - Phone:912-721-9499
Practice Address - Fax:912-721-9518
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164385363LW0102X
VA0001151070163W00000X
GARN226089363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04093OtherNC BC/BS
VA10029400NOtherSENTARA/OPTIMA
NC7004093Medicaid
VA1982679189Medicaid