Provider Demographics
NPI:1780998914
Name:KINCAID, JESSICA ANN
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANN
Last Name:KINCAID
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 1:2708 NE 14TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3564
Mailing Address - Country:US
Mailing Address - Phone:954-603-7885
Mailing Address - Fax:954-342-0273
Practice Address - Street 1:1432 ADKIN DR
Practice Address - Street 2:
Practice Address - City:IRON STATION
Practice Address - State:NC
Practice Address - Zip Code:28080-8404
Practice Address - Country:US
Practice Address - Phone:704-735-9693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist