Provider Demographics
NPI:1275789224
Name:KINCAID, SARAH J (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:KINCAID
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:KISTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1111 W KENYON RD STE B
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-1006
Mailing Address - Country:US
Mailing Address - Phone:217-819-3376
Mailing Address - Fax:217-729-7788
Practice Address - Street 1:1111 W KENYON RD STE B
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-1006
Practice Address - Country:US
Practice Address - Phone:217-819-3376
Practice Address - Fax:217-729-7788
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003257363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00650145OtherRAILROAD MEDICARE
IL279500OtherMEDICARE GROUP
IL0407950001Medicare NSC
ILP00650145OtherRAILROAD MEDICARE