Individual
TIMOTHY E KINKADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
404 JEFFERSON ST, PELLA, IA 50219-1257
(641) 628-6634
(913) 381-0979
Mailing address
8900 INDIAN CREEK PKWY, SUITE 500, OVERLAND PARK, KS 66210-1554
(913) 642-4900
(913) 381-0979
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
058017
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3265819
—
IA
Enumeration date
05/23/2006
Last updated
05/02/2012
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