Individual
JACOB KINCAID
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QBHP
Contact information
Practice address
707 N CARDINAL DR, MOUNTAIN HOME, AR 72653-3253
(870) 425-5644
Mailing address
2885 W BATTLEFIELD ST, SPRINGFIELD, MO 65807-3952
(417) 761-5000
(417) 761-5065
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
0000
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AR
Enumeration date
12/15/2021
Last updated
08/22/2022
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