Individual
RUSSELL JOHN KINSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
517 N MAIN ST, ANNA, IL 62906-1668
(618) 833-4511
(618) 833-4183
Mailing address
4971 S PALMER AVE, SPRINGFIELD, MO 65804-7482
(417) 380-1444
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.004652
IL
Other
Enumeration date
05/09/2013
Last updated
05/09/2013
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