Provider Demographics
NPI:1104709401
Name:KINCAID, REBECCA CATHERINE
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:CATHERINE
Last Name:KINCAID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 CARTER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25306-6288
Mailing Address - Country:US
Mailing Address - Phone:304-932-6282
Mailing Address - Fax:
Practice Address - Street 1:1 MOUNTAIN SIDE WAY
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:WV
Practice Address - Zip Code:25185-0001
Practice Address - Country:US
Practice Address - Phone:721-330-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program