Provider Demographics
NPI:1932184124
Name:VINCENT, KRISTIN LYNN (CNM)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:LYNN
Last Name:VINCENT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10609 BREMS CT
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46561
Mailing Address - Country:US
Mailing Address - Phone:574-400-2558
Mailing Address - Fax:574-400-2557
Practice Address - Street 1:10609 BREMS CT
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IN
Practice Address - Zip Code:46561-9097
Practice Address - Country:US
Practice Address - Phone:574-400-2558
Practice Address - Fax:574-400-2557
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72000084A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000780816OtherBCBS
IN200346930Medicaid
IN200965560Medicaid
IN200965560Medicaid
IN187670003Medicare PIN