Provider Demographics
NPI:1396714697
Name:KINCADE, TESSA A (MD)
Entity type:Individual
Prefix:DR
First Name:TESSA
Middle Name:A
Last Name:KINCADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S FLAGSTONE PATH CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-6620
Mailing Address - Country:US
Mailing Address - Phone:225-329-8976
Mailing Address - Fax:
Practice Address - Street 1:104 S FLAGSTONE PATH CIR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-6620
Practice Address - Country:US
Practice Address - Phone:225-329-8976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21573207V00000X
LAMD202513207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC215733Medicaid
SCH169717124OtherMEDICARE ID
SCH169717124OtherMEDICARE ID
SC215733Medicaid
SCH169711719Medicare ID - Type Unspecified