Healthcare Provider Details

I. General information

NPI: 1932109402
Provider Name (Legal Business Name): ROSA A KINCAID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6658 MEXICO RD
SAINT PETERS MO
63376-4131
US

IV. Provider business mailing address

2631 RUSSELL BLVD
SAINT LOUIS MO
63104-2135
US

V. Phone/Fax

Practice location:
  • Phone: 314-267-9082
  • Fax:
Mailing address:
  • Phone: 314-267-9082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMOR9N99
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMOR9N99
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: