Provider Demographics
NPI:1538186200
Name:KINNAMON, DEBORAH A (APN)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:A
Last Name:KINNAMON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2228
Mailing Address - Country:US
Mailing Address - Phone:816-271-7000
Mailing Address - Fax:816-271-0421
Practice Address - Street 1:1301 S BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2228
Practice Address - Country:US
Practice Address - Phone:816-271-7000
Practice Address - Fax:816-271-0421
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO089552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10001690400OtherCOMMUNITY HEALTH PLAN
P00195564OtherRR MEDICARE
P28145Medicare UPIN
10001690400OtherCOMMUNITY HEALTH PLAN