Provider Demographics
NPI:1831385343
Name:KINNARD, JAMEY PHILLIP (LPN)
Entity type:Individual
Prefix:
First Name:JAMEY
Middle Name:PHILLIP
Last Name:KINNARD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 COUNTY ROAD 347
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-8155
Mailing Address - Country:US
Mailing Address - Phone:870-598-9201
Mailing Address - Fax:
Practice Address - Street 1:1125 COUNTY ROAD 347
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-8155
Practice Address - Country:US
Practice Address - Phone:870-598-9201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007026919164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse