Provider Demographics
NPI:1356347751
Name:KINCANON, LYNN M (NP)
Entity type:Individual
Prefix:MISS
First Name:LYNN
Middle Name:M
Last Name:KINCANON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:970-624-1800
Mailing Address - Fax:970-624-1891
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE
Practice Address - Street 2:UNIT 100
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-624-1800
Practice Address - Fax:970-624-1891
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE61296363LF0000X
CO3127363L00000X
COAPN.0003127-NP363LA2200X
CORN.0124407163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37309072Medicaid
P64471Medicare UPIN
CO37309072Medicaid