Provider Demographics
NPI:1194564435
Name:KINCAID, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KINCAID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-0593
Mailing Address - Country:US
Mailing Address - Phone:318-435-7061
Mailing Address - Fax:318-435-7063
Practice Address - Street 1:PO BOX 593
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-0593
Practice Address - Country:US
Practice Address - Phone:318-435-7061
Practice Address - Fax:318-435-7063
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5059101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)