Provider Demographics
NPI:1477861797
Name:KINCAID, TERRY LEE (DPH)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:KINCAID
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 HIGHWAY 149
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-7205
Mailing Address - Country:US
Mailing Address - Phone:931-647-7227
Mailing Address - Fax:931-647-2194
Practice Address - Street 1:390 HIGHWAY 149
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-7205
Practice Address - Country:US
Practice Address - Phone:931-647-7227
Practice Address - Fax:931-647-2194
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist