Provider Demographics
NPI:1184410177
Name:KINCHEN, SHANTELL LIPSCOMB (RN)
Entity type:Individual
Prefix:
First Name:SHANTELL
Middle Name:LIPSCOMB
Last Name:KINCHEN
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11357 NUCKOLS RD # 2159
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5504
Mailing Address - Country:US
Mailing Address - Phone:804-510-0077
Mailing Address - Fax:803-617-0637
Practice Address - Street 1:11357 NUCKOLS RD # 2159
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5504
Practice Address - Country:US
Practice Address - Phone:804-510-0077
Practice Address - Fax:803-617-0637
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001328988163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse