Provider Demographics
NPI:1366403636
Name:PINCKARD-HANSEN, KAY C (MD)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:C
Last Name:PINCKARD-HANSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:(LINDA) KAY
Other - Middle Name:C
Other - Last Name:PINCKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1919 E THOMAS RD
Mailing Address - Street 2:BLDG 2108, SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7710
Mailing Address - Country:US
Mailing Address - Phone:602-512-8030
Mailing Address - Fax:602-512-8161
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-0777
Practice Address - Fax:602-933-0755
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17256208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ274720Medicaid
107909Medicare ID - Type Unspecified
AZ274720Medicaid