Provider Demographics
NPI:1952697799
Name:KINSEY, TINA MICHELLE
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MICHELLE
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:PO BOX 852135
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73085-2135
Mailing Address - Country:US
Mailing Address - Phone:405-308-6569
Mailing Address - Fax:
Practice Address - Street 1:12145 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7326
Practice Address - Country:US
Practice Address - Phone:405-308-6569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program