Provider Demographics
NPI:1093867798
Name:KINCER, KATHERINE B (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:B
Last Name:KINCER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 LUDLUM RD NW
Mailing Address - Street 2:
Mailing Address - City:ASH
Mailing Address - State:NC
Mailing Address - Zip Code:28420-3217
Mailing Address - Country:US
Mailing Address - Phone:910-540-1781
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1329
Practice Address - Country:US
Practice Address - Phone:910-642-8011
Practice Address - Fax:910-642-9328
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERNA203046367500000X
NC073343367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052383Medicaid
MERNA203046OtherRNA