Provider Demographics
NPI:1972575702
Name:KINSLOW, IVORY AMELIA (MD)
Entity type:Individual
Prefix:
First Name:IVORY
Middle Name:AMELIA
Last Name:KINSLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4566
Mailing Address - Country:US
Mailing Address - Phone:870-862-2340
Mailing Address - Fax:870-863-4951
Practice Address - Street 1:443 W OAK ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4566
Practice Address - Country:US
Practice Address - Phone:870-862-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7743207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180037761OtherRAILROAD MEDICARE
AR15205000000OtherQUALCHOICE
AR126721001Medicaid
AR126721001Medicaid
AR15205000000OtherQUALCHOICE
AR180037761OtherRAILROAD MEDICARE