Diedra Y Kinne
Individual provider Active NPI Peer Specialist · Fredonia, AZ
NPI 1275917379 · NPPES record last updated Jul 17, 2015
Key facts
- NPI
- 1275917379
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Peer Specialist 175T00000X
- License
- 4750887 (AZ)
- Practice address
- 240 West Jensen St.
Fredonia, AZ 86022-0491 - Phone
- (928) 925-0388
- NPI assigned
- Jul 17, 2015
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| 4750887 | AZ | MD | Peer Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 4750887 | AZ | Yes |
Addresses
Primary practice location
240 West Jensen St.
Fredonia, AZ 86022-0491
Mailing address
240 West Jensen St.
Fredonia, AZ 86022
Phone (928) 925-0388
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 Jul 17, 2015. 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.