Provider Demographics
NPI:1700624012
Name:KINCAID ENSIGN, DANA C (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:C
Last Name:KINCAID ENSIGN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:K
Other - Last Name:ENSIGN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:232 NUECES DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-1321
Mailing Address - Country:US
Mailing Address - Phone:361-834-7007
Mailing Address - Fax:
Practice Address - Street 1:232 NUECES DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-1321
Practice Address - Country:US
Practice Address - Phone:361-834-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX820474163W00000X
TXF07240654363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse