Individual provider Active NPI

Michelle Kinney

  • Family Nurse Practitioner
  • Marion, OH
National Provider Identifier
1710365903
Registry record updated May 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
COA.16677-NP Issued in OH
Practice address
320 Executive Dr
Marion, OH 43302
Phone
(740) 387-5210
NPI assigned
May 8, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X COA.16677-NP OH Primary

Addresses

Primary practice location

320 Executive Dr
Marion, OH 43302

Mailing address

320 Executive Dr
Marion, OH 43302-6373
Phone (740) 387-5210

Other practice location 1

1036 Mount Vernon Ave
Marion, OH 43302-5537
Phone (174) 038-9515

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150616002807 OH Practitioner - Nurse Practitioner 8527379668 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
COA.16677-NPOHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Third Street Community Clinic Inc CurrentSince Nov 1, 2023 Accepting new patients

Locations

2458 Stetzer Rd
Bucyrus, OH 44820
Phone (419) 562-2000

320 Executive Dr
Marion, OH 43302
Phone (740) 387-5210

1404 Park Ave W
Ste 2
Ontario, OH 44906

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558051200000",
    "number": "1710365903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 EXECUTIVE DR",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433026373",
            "telephone_number": "740-387-5210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 EXECUTIVE DR",
            "city": "MARION",
            "state": "OH",
            "postal_code": "43302",
            "telephone_number": "740-387-5210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1036 Mount Vernon Ave",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "OH",
            "postal_code": "433025537",
            "country_code": "US",
            "telephone_number": "174-038-9515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KINNEY",
        "first_name": "MICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-08",
        "last_updated": "2019-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA.16677-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, OH

Sources for this page

Verify at the official NPI Registry.