Individual
JAY KINCANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 CHILDRENS WAY # 653, LITTLE ROCK, AR 72202-3500
(501) 364-1100
(501) 526-5148
Mailing address
1 CHILDRENS WAY # 653, LITTLE ROCK, AR 72202-3500
(501) 364-1100
(501) 526-5148
Taxonomy
Speciality
Code
Description
License number
State
207NP0225X
Pediatric Dermatology Physician
Primary
C-6844
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119266001
—
AR
01
—
370005986
RAILROAD MEDICARE
AR
Enumeration date
10/09/2006
Last updated
03/17/2011
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