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General NPI Number Information
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NPI Number | 1184172579
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Entity Type | Organization
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Legal Business Name | IVORY A. KINSLOW, MDPA
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 310 THOMPSON AVE
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City | EL DORADO
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State | AR
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Zip | 71730-4569
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Country | US
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Telephone | 870-862-2340
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Fax | 870-862-2548
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Provider Business Mailing Address
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Address Line | 300 THOMPSON AVE
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City | EL DORADO
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State | AR
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Zip | 71730-4569
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Country | US
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Telephone | 870-862-2340
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Fax | 870-862-2548
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Authorized Official
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Title or Position | CEO
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Name | SHARON WINN
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Credential |
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Telephone | 870-862-2340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | C7743
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2574
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License Number State | AR
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