Basic Information
Provider Information
NPI: 1407387806
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KINCAID
FirstName: JOHN
MiddleName: C
NamePrefix:  
NameSuffix: JR.
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: KINCAID
OtherFirstName: CHARLIE
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 2
Mailing Information
Address1: PO BOX 251420
Address2:  
City: LITTLE ROCK
State: AR
PostalCode: 722251420
CountryCode: US
TelephoneNumber: 5016868000
FaxNumber: 5015265148
Practice Location
Address1: 4301 W MARKHAM ST # 508
Address2:  
City: LITTLE ROCK
State: AR
PostalCode: 722057101
CountryCode: US
TelephoneNumber: 5016868738
FaxNumber: 5016865927
Other Information
ProviderEnumerationDate: 03/27/2017
LastUpdateDate: 08/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/02/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XE-13750ARN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RH0002XE-13750ARY Allopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine

No ID Information.


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