Basic Information
| Provider Information | |||||||||
| NPI: | 1467457960 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINSEY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | ERNEST | ||||||||
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| Credential: | R.N., B.C., F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1332 PERRYVILLE RD | ||||||||
| Address2: | |||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637013808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733351830 | ||||||||
| FaxNumber: | 5732434700 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 S MOUNT AUBURN RD | ||||||||
| Address2: | SUITE 418 | ||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637034911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733326000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 03/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 107463 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 425702305 | 05 | MO | MEDICAID |