Basic Information
| Provider Information | |||||||||
| NPI: | 1588697890 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINSEL-EVANS | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | N. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KINSEL | ||||||||
| OtherFirstName: | HEATHER | ||||||||
| OtherMiddleName: | NIZHONII | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1725 WESTERN AVE STE A | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458401390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194234994 | ||||||||
| FaxNumber: | 3604286485 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 WESTERN AVE STE A | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458401390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194234994 | ||||||||
| FaxNumber: | 3604282596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 03/04/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD60270481 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD2009-0495 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MR-0873 | ID | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | R1064 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 35.143743 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | TIN & NPI | 01 | NM | BCBS OF NM | OTHER | 0474209 | 05 | OH | MEDICAID | 55279589 | 05 | NM | MEDICAID | 807491200 | 05 | ID | MEDICAID |