Provider Demographics
NPI:1861843633
Name:KINCAID, ALICIA R W (DO)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:R W
Last Name:KINCAID
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2338
Mailing Address - Country:US
Mailing Address - Phone:903-434-8044
Mailing Address - Fax:
Practice Address - Street 1:2001 N JEFFERSON AVE STE 203
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2310
Practice Address - Country:US
Practice Address - Phone:903-434-8880
Practice Address - Fax:903-434-8881
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016020856208600000X
COTL.0006478208600000X
TXT9426208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COTL.0006478OtherPHYSICIAN TRAINING LICENSE
MO2016020856OtherMISSOURI BOARD OF HEALING ARTS