=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093867798
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE B KINCER CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 07/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 HOSPITAL LN
-----------------------------------------------------
City | CALAIS
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04619-1329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-642-8011
-----------------------------------------------------
Fax | 910-642-9328
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6355 LUDLUM RD NW
-----------------------------------------------------
City | ASH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28420-3217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-540-1781
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | RNA203046
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 073343
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------