Provider Demographics
NPI:1083608202
Name:KINKADE, LINCOLN NATHANIEL (PT)
Entity Type:Individual
Prefix:
First Name:LINCOLN
Middle Name:NATHANIEL
Last Name:KINKADE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 UNIVERSITY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-7219
Mailing Address - Country:US
Mailing Address - Phone:304-598-2212
Mailing Address - Fax:304-225-5224
Practice Address - Street 1:3411 UNIVERSITY AVE STE 1
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-7219
Practice Address - Country:US
Practice Address - Phone:304-598-2212
Practice Address - Fax:304-598-2258
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9335682OtherGROUP
WV9335684OtherGROUP
WV0157306000Medicaid
001708627OtherBC BS
WV9335681OtherGROUP
WV001573OtherWV BOARD OF PT
WV9335683OtherGROUP
WV9335683OtherGROUP
WV9335682OtherGROUP
WVKI4063675Medicare PIN
WVKI4063672Medicare PIN