Healthcare Provider Details

I. General information

NPI: 1336784206
Provider Name (Legal Business Name): BARBARA KINKLE PA INC., A PHYSICIAN ASSISTANT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24575 HUNT AVE
CORNING CA
96021-8607
US

IV. Provider business mailing address

24575 HUNT AVE
CORNING CA
96021-8607
US

V. Phone/Fax

Practice location:
  • Phone: 530-356-9245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: BARBARA KINKLE
Title or Position: OWNER
Credential: PA
Phone: 530-356-9245