Basic Information
Provider Information
NPI: 1033476726
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HINKLE
FirstName: JAY
MiddleName: P
NamePrefix:  
NameSuffix:  
Credential:  
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Mailing Information
Address1: PO BOX 550
Address2:  
City: LOWELL
State: AR
PostalCode: 72745
CountryCode: US
TelephoneNumber: 4794637775
FaxNumber: 4794637187
Practice Location
Address1: 3336 N. FUTRALL
Address2:  
City: FAYETTEVILLE
State: AR
PostalCode: 72703
CountryCode: US
TelephoneNumber: 4794633000
FaxNumber: 4794633050
Other Information
ProviderEnumerationDate: 04/18/2012
LastUpdateDate: 11/07/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XE-9575ARN Allopathic & Osteopathic PhysiciansHospitalist 
2084N0400XE-9575ARY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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