Provider Demographics
NPI:1639268170
Name:KINKADE, VICKREY VAUGHN (APN)
Entity Type:Individual
Prefix:
First Name:VICKREY
Middle Name:VAUGHN
Last Name:KINKADE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 BROWNING WAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8348
Mailing Address - Country:US
Mailing Address - Phone:775-778-0386
Mailing Address - Fax:775-777-1152
Practice Address - Street 1:1775 BROWNING WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8348
Practice Address - Country:US
Practice Address - Phone:775-778-0386
Practice Address - Fax:775-777-1152
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN00364363LX0001X
NVRN19842363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002404011Medicaid