Kincannon, Jay

Kincannon, Jay is an individual health care provider with primary practice located at 1 Childrens Way # 653 , Little Rock AR 72202-3500. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Dermatology, which is considered as his primary health care specialty. Kincannon, Jay can be contacted via phone (501) 364-1100.

Contact Information

Primary practice address
1 Childrens Way # 653 Little Rock AR 72202-3500
Phone: (501) 364-1100
Fax: (501) 526-5148
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Dermatology 207NP0225X C-6844 Arkansas

Profile Details

NPI number 1184711236
LBN Legal business name Kincannon, Jay
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 9th, 2006
Last updated Mar 17th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184711236 NPPES
Arkansas MEDICAID 119266001
Arkansas Other 370005986

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