Provider Demographics
NPI:1982156972
Name:KINCAID, CARMEN (NP)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:KINCAID
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4444 W BRISTOL RD STE 150
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3161
Mailing Address - Country:US
Mailing Address - Phone:248-434-6169
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:4444 W BRISTOL RD STE 150
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3161
Practice Address - Country:US
Practice Address - Phone:248-434-6169
Practice Address - Fax:855-618-6655
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704287572363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology