Provider Demographics
NPI:1588998694
Name:KINCADE, MONICA L (RN, ACNS-BC, AGPCNP)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:L
Last Name:KINCADE
Suffix:
Gender:F
Credentials:RN, ACNS-BC, AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 E AMBER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-2456
Mailing Address - Country:US
Mailing Address - Phone:210-610-7283
Mailing Address - Fax:210-812-5938
Practice Address - Street 1:603 E AMBER ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-2456
Practice Address - Country:US
Practice Address - Phone:210-610-7283
Practice Address - Fax:210-812-5938
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX515807364SA2200X
TXAP118224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281187902Medicaid