MEDICARE: MISS LYNN M KINCANON N.P.

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	363LF0000X	Family Nurse Practitioner	61296	NE
2	363L00000X	Nurse Practitioner	3127	CO
3	363LA2200X	Adult Health Nurse Practitioner	APN.0003127-NP	CO
4	163W00000X	Registered Nurse	RN.0124407	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356347751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LYNN M KINCANON N.P.

Provider Business Mailing Address
First Line	:	2500 ROCKY MOUNTAIN AVE
Second Line	:	SUITE 100
City	:	LOVELAND
State	:	CO
Zip	:	80538-9004
Country	:	US
Telephone Number	:	970-624-1800
Fax Number	:	970-624-1891

Provider Business Practice Location Address
First Line	:	2500 ROCKY MOUNTAIN AVE
Second Line	:	UNIT 100
City	:	LOVELAND
State	:	CO
Zip	:	80538-9004
Country	:	US
Telephone Number	:	970-624-1800
Fax Number	:	970-624-1891

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	05/17/2016

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Directions to “ MISS LYNN M KINCANON N.P.” Practice Location

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