Provider Demographics
NPI:1235823790
Name:KINKOPH, MADELINE (NP)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:KINKOPH
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24560 SOUTHPOINT DR STE 260
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3505
Mailing Address - Country:US
Mailing Address - Phone:571-248-7472
Mailing Address - Fax:571-248-7493
Practice Address - Street 1:24560 SOUTHPOINT DR STE 260
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3505
Practice Address - Country:US
Practice Address - Phone:571-248-7472
Practice Address - Fax:571-248-7493
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187704363LP0808X
KY4030758363LP0808X
OHAPRN.CNP.0038009363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health