Individual
MRS. TANYA LYNN ANN KINKEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PLPC
Contact information
Practice address
309 GARRETT ST, FREDERICKTOWN, MO 63645-1084
(573) 783-4104
Mailing address
402 S SILVER SPRINGS RD, CAPE GIRARDEAU, MO 63703-7536
(573) 334-1100
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2023050856
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490139105
—
MO
Enumeration date
03/29/2024
Last updated
09/13/2024
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