Provider Demographics
NPI:1154547610
Name:DINNELLA, KERRY LYN (RN)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:LYN
Last Name:DINNELLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4716
Mailing Address - Country:US
Mailing Address - Phone:928-279-0109
Mailing Address - Fax:
Practice Address - Street 1:2126 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4716
Practice Address - Country:US
Practice Address - Phone:928-279-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN098843163WG0000X, 163WG0600X, 163WH0200X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care