Provider Demographics
NPI:1528180734
Name:KINKADE, WILLIAM E III (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:KINKADE
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 COLUMBINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436
Mailing Address - Country:US
Mailing Address - Phone:785-364-2116
Mailing Address - Fax:785-364-9613
Practice Address - Street 1:1110 COLUMBINE DRIVE
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436
Practice Address - Country:US
Practice Address - Phone:785-364-2116
Practice Address - Fax:785-364-9613
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01263363A00000X
KS15-01518363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS86431Medicare UPIN