Active NPI
Kelleigh Kincaid, FNTP, RWS, BCHN
- Nutritionist
- Portland, OR
National Provider Identifier
1861076697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 4428
- Practice address
- 2050 NE Hoyt St Apt 634
Portland, OR 97232-3660 - Phone
- (541) 880-4464
- NPI assigned
- May 7, 2021
- Last updated
- May 7, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 4428 | OR | Primary |
Addresses
Primary practice location
2050 NE Hoyt St Apt 634
Portland, OR 97232-3660
Mailing address
2050 NE Hoyt St Apt 634
Portland, OR 97232-3660
Phone (541) 880-4464
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4428 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620345600000",
"number": "1861076697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2050 NE HOYT ST APT 634",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972323660",
"telephone_number": "541-880-4464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2050 NE HOYT ST APT 634",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972323660",
"telephone_number": "541-880-4464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINCAID",
"first_name": "KELLEIGH",
"credential": "FNTP, RWS, BCHN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-07",
"last_updated": "2021-05-07",
"certification_date": "2021-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "OR",
"license": "4428",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.