Provider Demographics
NPI:1265433650
Name:KINCAID, DARLETTA JOAN (MD)
Entity type:Individual
Prefix:DR
First Name:DARLETTA
Middle Name:JOAN
Last Name:KINCAID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2429
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-8429
Mailing Address - Country:US
Mailing Address - Phone:972-420-1475
Mailing Address - Fax:214-222-2435
Practice Address - Street 1:760 N DENTON TAP RD
Practice Address - Street 2:SUITE 130
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2163
Practice Address - Country:US
Practice Address - Phone:972-420-1475
Practice Address - Fax:214-222-2435
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3518208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123938605Medicaid
TX81M642OtherBCBS
E33687Medicare UPIN