Provider Demographics
NPI:1528666849
Name:KINCHEN, ANNE MARIE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:KINCHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-3948
Mailing Address - Country:US
Mailing Address - Phone:501-800-3891
Mailing Address - Fax:
Practice Address - Street 1:1548 W 10TH ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-3948
Practice Address - Country:US
Practice Address - Phone:501-800-3891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR908801789172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver