Healthcare Provider Details

I. General information

NPI: 1730737925
Provider Name (Legal Business Name): JENNIFER KINCAID RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FLAT TOP RD
SHADY SPRING WV
25918-8615
US

IV. Provider business mailing address

105 ADAIR ST
BECKLEY WV
25801-3733
US

V. Phone/Fax

Practice location:
  • Phone: 304-256-4570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number46638
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: