Healthcare Provider Details

I. General information

NPI: 1174343636
Provider Name (Legal Business Name): RACHEL LIANNE KINCY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

3425 SNOW PARK LN W APT 202
MEMPHIS TN
38119-2613
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-4343
  • Fax:
Mailing address:
  • Phone: 731-358-8060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberPENDING
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: