Provider Demographics
NPI:1023194347
Name:KINCHELOE, JOHN ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLEN
Last Name:KINCHELOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W HASKELL ST
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-3782
Mailing Address - Country:US
Mailing Address - Phone:775-625-4653
Mailing Address - Fax:775-625-7004
Practice Address - Street 1:515 W HASKELL ST
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3782
Practice Address - Country:US
Practice Address - Phone:775-625-4653
Practice Address - Fax:775-625-7004
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine