Provider Demographics
NPI:1699069997
Name:KINNAIRD, ASHLEY IDIAQUEZ (NP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:IDIAQUEZ
Last Name:KINNAIRD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2818
Mailing Address - Country:US
Mailing Address - Phone:252-847-5473
Mailing Address - Fax:252-847-8353
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-847-5473
Practice Address - Fax:252-847-8353
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005528363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5005528OtherNC BOARD OF NURSING: ANP LICENSE
FLARNP9243368OtherFLORIDA LICENSE
FLFF834ZOtherMEDICARE PROVIDER NUMBER