Provider Demographics
NPI:1841876174
Name:KINKEAD, KATELYN ELIZABETH (APRN-CNP, CPNP-PC)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ELIZABETH
Last Name:KINKEAD
Suffix:
Gender:F
Credentials:APRN-CNP, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 SILVER LN STE B
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4575
Mailing Address - Country:US
Mailing Address - Phone:614-933-0980
Mailing Address - Fax:614-933-0334
Practice Address - Street 1:470 SILVER LN STE B
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4575
Practice Address - Country:US
Practice Address - Phone:614-933-0980
Practice Address - Fax:614-933-0334
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029671363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0458958Medicaid