Thomas Charles Kinne II
Individual provider Active NPI Respite Care · Fredonia, AZ
NPI 1003315151 · NPPES record last updated Feb 5, 2018
Key facts
- NPI
- 1003315151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Respite Care 385H00000X
- License
- 8876774 (AZ)
- Practice address
- 314 Aspen Street
Fredonia, AZ 86022 - Phone
- (928) 925-5992
- NPI assigned
- Feb 5, 2018
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8876774 | AZ | MD | Respite Care |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Respite Care | 385H00000X | 8876774 | AZ | Yes |
Addresses
Primary practice location
314 Aspen Street
Fredonia, AZ 86022
Mailing address
PO Box 491
Fredonia, AZ 86022-0491
Phone (928) 925-5992
Other providers in Fredonia, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.