Provider Demographics
NPI:1447469085
Name:KINNEY, BENTON CLAY (PA)
Entity type:Individual
Prefix:MR
First Name:BENTON
Middle Name:CLAY
Last Name:KINNEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1999 SALZBURG TRL
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-9334
Mailing Address - Country:US
Mailing Address - Phone:530-209-5978
Mailing Address - Fax:530-275-2201
Practice Address - Street 1:2865 CHURN CREEK RD
Practice Address - Street 2:SUITE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1117
Practice Address - Country:US
Practice Address - Phone:530-646-7269
Practice Address - Fax:530-275-2201
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16208363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA006799550Medicaid
CW828YMedicare Oscar/Certification
CA006799550Medicaid