Individual
TARA M KINNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3400 DEXTER CT STE 104, DAVENPORT, IA 52807-3419
(563) 334-0234
(563) 334-0235
Mailing address
3400 DEXTER CT STE 104, DAVENPORT, IA 52807-3419
(563) 334-0234
(563) 334-0235
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209009089
IL
367500000X
Certified Registered Nurse Anesthetist
R1566983
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
01
—
P00849727
RAILROAD MEDICARE
MN
Enumeration date
04/09/2010
Last updated
10/26/2020
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