Provider Demographics
NPI:1134231004
Name:KINNEY, JOAN FRANCES (NP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:FRANCES
Last Name:KINNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5088 CONDE CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2406
Mailing Address - Country:US
Mailing Address - Phone:510-490-1914
Mailing Address - Fax:
Practice Address - Street 1:5088 CONDE CT
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2406
Practice Address - Country:US
Practice Address - Phone:510-490-1914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB198223363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1172163Medicare UPIN