Provider Demographics
NPI:1487944146
Name:KINNEY, EDWARD VERNON (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:VERNON
Last Name:KINNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S POPE LICK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4708
Mailing Address - Country:US
Mailing Address - Phone:651-717-5959
Mailing Address - Fax:502-261-8212
Practice Address - Street 1:2600 S POPE LICK RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-4708
Practice Address - Country:US
Practice Address - Phone:651-717-5959
Practice Address - Fax:502-261-8212
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24060207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC71187Medicare UPIN