Basic Information
| Provider Information | |||||||||
| NPI: | 1891924809 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NORRIS | ||||||||
| FirstName: | KINZIE | ||||||||
| MiddleName: | ADELE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MATLOCK | ||||||||
| OtherFirstName: | KINZIE | ||||||||
| OtherMiddleName: | ADELE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 301 N 27TH ST | ||||||||
| Address2: | STE 11 | ||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687014401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058800316 | ||||||||
| FaxNumber: | 4028448144 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 N 27TH ST | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687014401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058800316 | ||||||||
| FaxNumber: | 4028448122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2009 | ||||||||
| LastUpdateDate: | 02/14/2017 | ||||||||
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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 | 2086X0206X | 29863 | NE | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 348449501 | 05 | TX | MEDICAID |