MEDICARE: AMANDA LYNN KINCAID

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	5012489	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5012489	OTHER	NC	APRN

General Provider Information

NPI Number	:	1225672959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LYNN KINCAID

Provider Business Mailing Address
First Line	:	160 RIVER BEND DR STE A
Second Line	:
City	:	GRANITE FALLS
State	:	NC
Zip	:	28630-9371
Country	:	US
Telephone Number	:	828-757-5060
Fax Number	:

Provider Business Practice Location Address
First Line	:	8439 VALLEY BLVD
Second Line	:
City	:	BLOWING ROCK
State	:	NC
Zip	:	28605-8957
Country	:	US
Telephone Number	:	828-295-3116
Fax Number	:	828-295-4388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	12/18/2024

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Directions to “ AMANDA LYNN KINCAID ” Practice Location

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