Provider Demographics
NPI:1851180673
Name:KINCADE, ALLYSSA NICOLE (FNP-C)
Entity type:Individual
Prefix:
First Name:ALLYSSA
Middle Name:NICOLE
Last Name:KINCADE
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 W CAMELBACK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-3030
Mailing Address - Country:US
Mailing Address - Phone:602-639-2831
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 11097
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85061-1097
Practice Address - Country:US
Practice Address - Phone:855-428-5673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ322504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily