Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 26NJ00312200 | NJ |
N | 363LP0200X | Nurse Practitioner - Pediatrics | SP010984 | PA |
NPI | 1043511611 |
---|---|
Provider Name | Mr. Michael Joseph Kinney |
First Address | Sewell, NJ 08080-9340 |
Second Address | Sewell, NJ 08080-9340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2010 |
Last Update Date | 26/10/2015 |