Provider Demographics
NPI:1144112939
Name:KINNEY, ALISHA LEIGH (AGNP-C)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:LEIGH
Last Name:KINNEY
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 BLACKHAWK DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2811
Mailing Address - Country:US
Mailing Address - Phone:920-539-0726
Mailing Address - Fax:
Practice Address - Street 1:13133 N PORT WASHINGTON RD STE 104
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2422
Practice Address - Country:US
Practice Address - Phone:262-243-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17096363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care