Provider Demographics
NPI:1124627609
Name:KINCAID, CRYSTAL DAWN
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DAWN
Last Name:KINCAID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SHADY SPRING
Mailing Address - State:WV
Mailing Address - Zip Code:25918-8423
Mailing Address - Country:US
Mailing Address - Phone:304-575-8255
Mailing Address - Fax:
Practice Address - Street 1:368 1ST ST
Practice Address - Street 2:
Practice Address - City:SHADY SPRING
Practice Address - State:WV
Practice Address - Zip Code:25918-8423
Practice Address - Country:US
Practice Address - Phone:304-575-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant