Individual
JESSICA LYNN KINNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 629-1186
Mailing address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 629-1186
(269) 488-8313
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601006121
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5390153
BCBS
MI
Enumeration date
08/26/2011
Last updated
02/02/2021
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