Provider Demographics
NPI:1265168967
Name:KINCHION, MARTINA
Entity type:Individual
Prefix:MRS
First Name:MARTINA
Middle Name:
Last Name:KINCHION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARTINA
Other - Middle Name:
Other - Last Name:GITAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1200 S 10TH ST UNIT 703
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2636
Mailing Address - Country:US
Mailing Address - Phone:316-727-9103
Mailing Address - Fax:
Practice Address - Street 1:1200 S 10TH ST UNIT 703
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2636
Practice Address - Country:US
Practice Address - Phone:316-727-9103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13114375163WW0000X, 163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WW0000XNursing Service ProvidersRegistered NurseWound Care