Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH6612 | FL |
NPI | 1003880337 |
---|---|
Provider Name | Dr. Laura Ann Kinkead |
First Address | New Port Richey, FL 34652-2605 |
Second Address | New Port Richey, FL 34652-2605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 26/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
380322800 | (05) | FL |
U44143 | (02) | FL |