Provider Demographics
NPI:1285200535
Name:KINKADE, KATHLEEN PAISLEY (LAC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:PAISLEY
Last Name:KINKADE
Suffix:
Gender:F
Credentials:LAC
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 95
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-0095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 MAIN ST STE 1A
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3542
Practice Address - Country:US
Practice Address - Phone:631-446-1046
Practice Address - Fax:631-446-1300
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006197171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist