Provider Demographics
NPI:1487022349
Name:BRINCEFIELD, KAY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:
Last Name:BRINCEFIELD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18081 VONORE RD
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-4013
Mailing Address - Country:US
Mailing Address - Phone:352-208-4494
Mailing Address - Fax:
Practice Address - Street 1:700 WILLIAMS FERRY RD
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-7375
Practice Address - Country:US
Practice Address - Phone:865-986-3583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT4999313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility