Provider Demographics
NPI:1538158332
Name:LAURIN KINNEY, JAYNE (NP)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:LAURIN KINNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BOSTON ROAD
Mailing Address - Street 2:STUIE F
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-0000
Mailing Address - Country:US
Mailing Address - Phone:978-577-0437
Mailing Address - Fax:978-448-6707
Practice Address - Street 1:100 BOSTON ROAD
Practice Address - Street 2:SUITE F
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-0000
Practice Address - Country:US
Practice Address - Phone:978-577-0437
Practice Address - Fax:978-448-6707
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA143288363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics