Provider Demographics
NPI:1336784206
Name:BARBARA KINKLE PA INC., A PHYSICIAN ASSISTANT CORPORATION
Entity type:Organization
Organization Name:BARBARA KINKLE PA INC., A PHYSICIAN ASSISTANT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:530-356-9245
Mailing Address - Street 1:24575 HUNT AVE
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-8607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24575 HUNT AVE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-8607
Practice Address - Country:US
Practice Address - Phone:530-356-9245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty