Provider Demographics
NPI:1962845347
Name:KINARD, JACQUELYNN NICHOLE (MD)
Entity type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:NICHOLE
Last Name:KINARD
Suffix:
Gender:
Credentials:MD
Other - Prefix:MISS
Other - First Name:JACQUELYNN
Other - Middle Name:NICHOLE
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 BELCHER ST
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35042-2946
Mailing Address - Country:US
Mailing Address - Phone:205-926-2992
Mailing Address - Fax:
Practice Address - Street 1:1308 TUSCALOOSA AVE SW
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1948
Practice Address - Country:US
Practice Address - Phone:205-679-6325
Practice Address - Fax:205-783-8600
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52530207Q00000X
AL50838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine