Provider Demographics
NPI:1376576819
Name:KINCADE, ANDREW JEFFERSON (BS)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JEFFERSON
Last Name:KINCADE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 JUDITH DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1924
Mailing Address - Country:US
Mailing Address - Phone:423-979-2946
Mailing Address - Fax:423-979-3447
Practice Address - Street 1:SIDNEY & LAMONT ST.
Practice Address - Street 2:JAMES H. QUILLEN VAMC
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-979-2946
Practice Address - Fax:423-979-3447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)