Provider Demographics
NPI:1053374074
Name:KINCEL, KATHRYN MARI LIN (PAC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARI LIN
Last Name:KINCEL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 E FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3048
Mailing Address - Country:US
Mailing Address - Phone:208-967-2597
Mailing Address - Fax:
Practice Address - Street 1:43658 STATE HIGHWAY 299 E
Practice Address - Street 2:
Practice Address - City:FALL RIVER MILLS
Practice Address - State:CA
Practice Address - Zip Code:96028-9819
Practice Address - Country:US
Practice Address - Phone:530-999-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15892363AM0700X
WAPA10004548363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP75184Medicare UPIN