=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699650838
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2025
-----------------------------------------------------
Last Update Date | 10/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 S SARAH ST
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63108-2819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-267-9082
-----------------------------------------------------
Fax | 949-864-3741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 S SARAH ST
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63108-2819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-267-9082
-----------------------------------------------------
Fax | 949-864-3741
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROSA KINCAID
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 314-267-9082
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------