Healthcare Provider Details

I. General information

NPI: 1639584790
Provider Name (Legal Business Name): KATHRYN KINCAIDE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 NW MURRAY ROAD
LEE'S SUMMIT MO
64081
US

IV. Provider business mailing address

10807 COUNTRY LN
PECULIAR MO
64078-9341
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-4400
  • Fax: 816-525-9045
Mailing address:
  • Phone: 816-522-1666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014019280
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: