Healthcare Provider Details

I. General information

NPI: 1033517719
Provider Name (Legal Business Name): STEFANIE L. KINCEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 HAVEN DR
DOTHAN AL
36301-2919
US

IV. Provider business mailing address

207 HAVEN DR DOTHAN HYPERTENSION - NEPHROLOGY, ASSOCIATES, P.C
DOTHAN AL
36301-2919
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-3319
  • Fax: 334-699-3349
Mailing address:
  • Phone: 334-793-3319
  • Fax: 334-699-3349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1114414
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License Number1114414
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: