Basic Information
| Provider Information | |||||||||
| NPI: | 1710489349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINNEY | ||||||||
| FirstName: | ADRIENNE | ||||||||
| MiddleName: | BETH | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1714 DOE RUN DR | ||||||||
| Address2: | |||||||||
| City: | VANDALIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624713608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182670497 | ||||||||
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| Practice Location | |||||||||
| Address1: | 503 N MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173422121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2018 | ||||||||
| LastUpdateDate: | 03/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 209.017242 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 363L00000X | 2019046865 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 209.017242 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.