Provider Demographics
NPI:1801484357
Name:KINSEY, JESSE VIDIC (RN)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:VIDIC
Last Name:KINSEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 CASTLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-8606
Mailing Address - Country:US
Mailing Address - Phone:406-564-5453
Mailing Address - Fax:
Practice Address - Street 1:147 CASTLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-8606
Practice Address - Country:US
Practice Address - Phone:406-564-5453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-38036163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse