Basic Information
| Provider Information | |||||||||
| NPI: | 1780998914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINCAID | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2708 NE 14TH ST APT 5 | ||||||||
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| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330623564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546037885 | ||||||||
| FaxNumber: | 9543420273 | ||||||||
| Practice Location | |||||||||
| Address1: | 1432 ADKIN DR | ||||||||
| Address2: | |||||||||
| City: | IRON STATION | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280808404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047359693 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2010 | ||||||||
| LastUpdateDate: | 07/29/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist |
No ID Information.