Bryan Kelly Kincannon

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2052172 Issued in TX

Practice address

632 Windsor Way
Van Alstyne, TX 75495

Phone

(903) 482-9324

Fax

(903) 482-9346

NPI assigned

Jan 10, 2011

Last updated

Jan 10, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294617600000",
    "number": "1780988444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 EQUINE LN",
            "city": "CELINA",
            "state": "TX",
            "postal_code": "750094666",
            "telephone_number": "806-223-5757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "632 WINDSOR WAY",
            "city": "VAN ALSTYNE",
            "state": "TX",
            "postal_code": "75495",
            "telephone_number": "903-482-9324",
            "fax_number": "903-482-9346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINCANNON",
        "first_name": "BRYAN",
        "middle_name": "KELLY",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-10",
        "last_updated": "2011-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2052172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annelle Rae Johnson, MD
• Christine Anne Johnson, LMFT, RN
• Margaret Anne Jones, APRN, FNP-C
• Irine K Karani, LVN
• Kids Choice Home Health Inc
• Roger Alan King, L.P.T.
• Polly Knight, MD
• Sara Leclear, FNP
• Lilly's Home Health Care LLC
• Jackson Matthew Lloyd, DDS

• Physical Therapy Assistant in Van Alstyne, TX
• Providers in Van Alstyne, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.