Provider Demographics
NPI:1104262757
Name:KINKLE, BARBARA JEAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JEAN
Last Name:KINKLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5250
Mailing Address - Country:US
Mailing Address - Phone:909-798-9403
Mailing Address - Fax:909-335-1641
Practice Address - Street 1:124 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5250
Practice Address - Country:US
Practice Address - Phone:909-798-9403
Practice Address - Fax:909-335-1641
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22651363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant