Basic Information
| Provider Information | |||||||||
| NPI: | 1194905885 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'BRIEN-KINNE | ||||||||
| FirstName: | JERE | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 S HIGLEY RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852064000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806152010 | ||||||||
| FaxNumber: | 4806322786 | ||||||||
| Practice Location | |||||||||
| Address1: | 3493 S MERCY RD | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852970434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807320044 | ||||||||
| FaxNumber: | 4806322786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2007 | ||||||||
| LastUpdateDate: | 06/05/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | RN165700/AP3905 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.