Provider Demographics
NPI:1598563900
Name:KINSLEY, TIFFANY RAE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RAE
Last Name:KINSLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566-1835
Mailing Address - Country:US
Mailing Address - Phone:712-612-5221
Mailing Address - Fax:
Practice Address - Street 1:1750 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3814
Practice Address - Country:US
Practice Address - Phone:712-215-6588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP48211164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse