Provider Demographics
NPI:1043889652
Name:KINCAID, CHRISTY MARIE (CD(DONA))
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:MARIE
Last Name:KINCAID
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 22ND ST N
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49037-8153
Mailing Address - Country:US
Mailing Address - Phone:269-998-7539
Mailing Address - Fax:
Practice Address - Street 1:286 22ND ST N
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49037-8153
Practice Address - Country:US
Practice Address - Phone:269-998-7539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13975374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
13975OtherDONA INTERNATIONAL