Individual
HOLLY ROXANNE KINNELL-RUST
Active
Individual
HOLLY ROXANNE KINNELL-RUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
191964
MA
363LF0000X
Family Nurse Practitioner
2010026851
MO
363LF0000X
Family Nurse Practitioner
Primary
7023
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008073029
—
CT
05
—
184085758
—
AR
05
—
1932287893
—
MO
01
—
431560263
TRICARE WEST
—
01
—
P00859525
RAILROAD MEDICARE
—
Enumeration date
11/01/2006
Last updated
07/15/2019
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