Provider Demographics
NPI:1093245235
Name:KINKEAD, NICHOLAS B
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:B
Last Name:KINKEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:NE
Mailing Address - Zip Code:68450-0538
Mailing Address - Country:US
Mailing Address - Phone:402-335-2811
Mailing Address - Fax:402-335-2826
Practice Address - Street 1:202 HIGH ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:NE
Practice Address - Zip Code:68450-2443
Practice Address - Country:US
Practice Address - Phone:402-335-2811
Practice Address - Fax:402-335-2826
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2130363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant