Healthcare Provider Details

I. General information

NPI: 1114598794
Provider Name (Legal Business Name): KATHLEEN ELIZABETH KINCAID ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SE WASHINGTON STREET
PULLMAN WA
99164-9686
US

IV. Provider business mailing address

2135 NW CANYON VIEW DR
PULLMAN WA
99163-6011
US

V. Phone/Fax

Practice location:
  • Phone: 509-335-3575
  • Fax:
Mailing address:
  • Phone: 509-595-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61189503
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: