Individual
RICKEY DALE KINZEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
400 MANN ST STE 107, CORPUS CHRISTI, TX 78401-2046
(361) 533-9911
Mailing address
2100 MARKET ST STE 101, CHARLESTOWN, IN 47111-9535
(812) 503-5100
(770) 573-9513
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
02000860A
IN
207Q00000X
Family Medicine Physician
02000860A
IN
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
02000860C
IN
207QA0401X
Addiction Medicine (Family Medicine) Physician
T1985
TX
207RA0401X
Addiction Medicine (Internal Medicine) Physician
T1985
TX
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000368845
RKP ANTHEM
IN
01
—
000000368855
RKA ANTHEM
IN
05
—
100446040
—
IN
05
—
434219808
—
TX
Enumeration date
09/14/2005
Last updated
03/25/2025
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