Provider Demographics
NPI:1982785986
Name:KINCAID, WAYLON MATTHEW (PA-C)
Entity Type:Individual
Prefix:
First Name:WAYLON
Middle Name:MATTHEW
Last Name:KINCAID
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37456 COAL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WHITESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25209-0187
Mailing Address - Country:US
Mailing Address - Phone:304-854-1321
Mailing Address - Fax:304-854-1031
Practice Address - Street 1:37456 COAL RIVER ROAD
Practice Address - Street 2:
Practice Address - City:WHITESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25209-0187
Practice Address - Country:US
Practice Address - Phone:304-854-1321
Practice Address - Fax:304-854-1031
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV747363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP97101Medicare UPIN