Healthcare Provider Details

I. General information

NPI: 1265031280
Provider Name (Legal Business Name): AMANDA KINCADE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 WITTENBRAKER AVE
NEW CASTLE IN
47362-5035
US

IV. Provider business mailing address

9830 N COUNTY ROAD 450 W
CAMBRIDGE CITY IN
47327-9505
US

V. Phone/Fax

Practice location:
  • Phone: 765-878-6700
  • Fax:
Mailing address:
  • Phone: 765-541-8499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-82274
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: