Provider Demographics
NPI:1669500799
Name:KINCAID, CRYSTAL L (DPM)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:L
Last Name:KINCAID
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-7604
Mailing Address - Country:US
Mailing Address - Phone:859-737-8528
Mailing Address - Fax:859-737-8529
Practice Address - Street 1:225 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-7604
Practice Address - Country:US
Practice Address - Phone:859-737-8528
Practice Address - Fax:859-737-8529
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00298213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100024890Medicaid
KYK098320Medicare PIN