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Individual
M JEANETTE KINMAN
Active
Individual
M JEANETTE KINMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP,C
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71005061A
IN
363LP2300X
Primary Care Nurse Practitioner
28135612A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000942055
ANTHEM
IN
01
—
12758051
CAQH
—
05
—
200875910
—
IN
01
—
834950005
MEDICARE
IN
Enumeration date
12/19/2007
Last updated
10/09/2015
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