Provider Demographics
NPI:1366036014
Name:KINCAID, GAIL LYNN
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:LYNN
Last Name:KINCAID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 LICK RUN RD
Mailing Address - Street 2:
Mailing Address - City:STOCKPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43787-9237
Mailing Address - Country:US
Mailing Address - Phone:740-516-1736
Mailing Address - Fax:
Practice Address - Street 1:7988 ST RT 377
Practice Address - Street 2:CHESTERHILL
Practice Address - City:CHESTERHILL
Practice Address - State:OH
Practice Address - Zip Code:43728-4372
Practice Address - Country:US
Practice Address - Phone:740-554-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRH717399172A00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0114752Medicaid