Provider Demographics
NPI:1962493627
Name:KINCANNON, JESSICA LEE (CMF)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEE
Last Name:KINCANNON
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 S DANVILLE DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-7250
Mailing Address - Country:US
Mailing Address - Phone:325-892-3414
Mailing Address - Fax:325-695-0131
Practice Address - Street 1:4150 S DANVILLE DR
Practice Address - Street 2:SUITE 10
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-7250
Practice Address - Country:US
Practice Address - Phone:325-892-3414
Practice Address - Fax:325-695-0131
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist