Provider Demographics
NPI:1447736491
Name:KINSEY, JOHN MARTIN (FNP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MARTIN
Last Name:KINSEY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6414 HWY 98 WEST
Mailing Address - Street 2:70
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-4612
Mailing Address - Country:US
Mailing Address - Phone:601-298-1881
Mailing Address - Fax:
Practice Address - Street 1:6414 HWY 98 WEST
Practice Address - Street 2:70
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3940
Practice Address - Country:US
Practice Address - Phone:601-298-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-12
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK134781207Q00000X
MS902780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine