Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 1025056458 | IL |
N | 111NI0900X | Internist | 1025056458 | IL |
N | 207R00000X | Internist | 4301106776 | MI |
N | 111NI0900X | Internist | 4301106776 | MI |
N | 207RG0100X | Gastroenterologist | 4301106776 | MI |
Y | 207RG0100X | Gastroenterologist | ME152798 | FL |
NPI | 1003045634 |
---|---|
Provider Name | Dr. Jami Ann Rothe Kinnucan |
First Address | Jacksonville, FL 32224-1865 |
Second Address | Jacksonville, FL 32224-1865 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2009 |
Last Update Date | 21/01/2022 |