MEDICARE: MS. DELLA M KINCAID RN

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	163WC0400X	Case Management Registered Nurse	1027282	KY

General Provider Information

NPI Number	:	1760602270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DELLA M KINCAID RN

Provider Business Mailing Address
First Line	:	95 EDMONDS LANE
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642-9529
Country	:	US
Telephone Number	:	270-866-2720
Fax Number	:	270-866-7848

Provider Business Practice Location Address
First Line	:	95 EDMONDS LANE
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642-9529
Country	:	US
Telephone Number	:	270-866-7848
Fax Number	:	270-866-7848

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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