Healthcare Provider Details

I. General information

NPI: 1528666849
Provider Name (Legal Business Name): ANNE MARIE KINCHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1548 W 10TH ST
NORTH LITTLE ROCK AR
72114-3948
US

IV. Provider business mailing address

1548 W 10TH ST
NORTH LITTLE ROCK AR
72114-3948
US

V. Phone/Fax

Practice location:
  • Phone: 501-800-3891
  • Fax:
Mailing address:
  • Phone: 501-800-3891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number908801789
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: