Provider Demographics
NPI:1417902909
Name:KINKADE, TIMOTHY E (CRNA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:KINKADE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 INDIAN CREEK PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1554
Mailing Address - Country:US
Mailing Address - Phone:913-642-4900
Mailing Address - Fax:913-381-0979
Practice Address - Street 1:404 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1257
Practice Address - Country:US
Practice Address - Phone:641-628-6634
Practice Address - Fax:913-381-0979
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA058017367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3265819Medicaid
IAP00429674Medicare PIN
IAI19306Medicare PIN
R04386Medicare UPIN