Provider Demographics
NPI:1396105961
Name:KINNEY, DANIELLE M (CNP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:KINNEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E MOUND ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43019-9022
Mailing Address - Country:US
Mailing Address - Phone:740-507-9424
Mailing Address - Fax:740-383-7494
Practice Address - Street 1:1300 MARION AGOSTA RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-9535
Practice Address - Country:US
Practice Address - Phone:740-507-9424
Practice Address - Fax:740-383-7494
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18837363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner