Provider Demographics
NPI:1427530971
Name:KINNEY, TRACIE (NP-C)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:KINNEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-3293
Mailing Address - Fax:
Practice Address - Street 1:1501 CHESTER BLVD.
Practice Address - Street 2:REID URGENT CARE
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374
Practice Address - Country:US
Practice Address - Phone:765-935-1905
Practice Address - Fax:765-935-1910
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28160004A163W00000X
IN71008285A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse