Provider Demographics
NPI:1194869883
Name:KINNEY, TERRY D (PA-C)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:D
Last Name:KINNEY
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Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:707 S GRADY WAY
Mailing Address - Street 2:STE 600
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3227
Mailing Address - Country:US
Mailing Address - Phone:206-823-1004
Mailing Address - Fax:206-309-3319
Practice Address - Street 1:645 ANTELOPE BLVD
Practice Address - Street 2:SUITE # 24
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96019
Practice Address - Country:US
Practice Address - Phone:530-528-7650
Practice Address - Fax:530-528-7655
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2022-07-22
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Provider Licenses
StateLicense IDTaxonomies
WAPA60316881363A00000X
CAPA18663363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant