Provider Demographics
NPI:1649632274
Name:KINNA, BRYANNA ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:BRYANNA
Middle Name:ELIZABETH
Last Name:KINNA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRYANNA
Other - Middle Name:ELIZABETH
Other - Last Name:EVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:131 JPM RD STE A
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9309
Practice Address - Country:US
Practice Address - Phone:570-523-6115
Practice Address - Fax:570-523-6178
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003810363A00000X
PAMA058232363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031819960001Medicaid
PA523631F6KMedicare PIN