Provider Demographics
NPI:1013483080
Name:KINSEY, ANDREA L
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:KINSEY
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 1:4129 FABULOUS FINCHES AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-4810
Mailing Address - Country:US
Mailing Address - Phone:702-336-4715
Mailing Address - Fax:
Practice Address - Street 1:4129 FABULOUS FINCHES AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-4810
Practice Address - Country:US
Practice Address - Phone:702-336-4715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician