Provider Demographics
NPI:1609178987
Name:KINNEY, TERESA LYNN (APRN)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LYNN
Last Name:KINNEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 W LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-1022
Mailing Address - Country:US
Mailing Address - Phone:217-497-9904
Mailing Address - Fax:
Practice Address - Street 1:408 W LAKE BLVD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1022
Practice Address - Country:US
Practice Address - Phone:217-497-9904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006732363LF0000X
IN71005686A363LF0000X
IL209008489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily