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Individual
MS. KADIAN MCINTOSH
Active
Individual
MS. KADIAN MCINTOSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA05091
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205209401
—
TX
05
—
205209402
—
TX
05
—
205209403
—
TX
05
—
205209404
—
TX
01
—
800N57
BLUE CROSS BLUE SHIELD
TX
01
—
8Y0773
BCBS
TX
01
—
P01070314
RR MEDICARE
TX
Enumeration date
11/04/2006
Last updated
03/20/2015
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