Provider Demographics
NPI:1922146752
Name:KINKEAD, KATHLEEN J (LMP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:J
Last Name:KINKEAD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 S 2ND ST
Mailing Address - Street 2:SUITE 710
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2632
Mailing Address - Country:US
Mailing Address - Phone:509-895-7888
Mailing Address - Fax:
Practice Address - Street 1:6 S 2ND ST
Practice Address - Street 2:SUITE 710
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2632
Practice Address - Country:US
Practice Address - Phone:509-895-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011675225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA140 408OtherL&I
WA8942958OtherCRIME VICTIMS L&I