Provider Demographics
NPI:1881366581
Name:KINCADE, REBECCA A (IDHS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:KINCADE
Suffix:
Gender:F
Credentials:IDHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MORICHES ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-1315
Mailing Address - Country:US
Mailing Address - Phone:631-395-4435
Mailing Address - Fax:
Practice Address - Street 1:100 MORICHES ISLAND ROAD
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940
Practice Address - Country:US
Practice Address - Phone:631-395-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman