Provider Demographics
NPI:1639584790
Name:KINCAIDE, KATHRYN (NP-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KINCAIDE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10807 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-9341
Mailing Address - Country:US
Mailing Address - Phone:816-522-1666
Mailing Address - Fax:
Practice Address - Street 1:506 NW MURRAY ROAD
Practice Address - Street 2:
Practice Address - City:LEE'S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081
Practice Address - Country:US
Practice Address - Phone:816-525-4400
Practice Address - Fax:816-525-9045
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014019280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily