Provider Demographics
NPI:1063498301
Name:KINARD, STEPHEN A (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:KINARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14759
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27620-4759
Mailing Address - Country:US
Mailing Address - Phone:252-824-7700
Mailing Address - Fax:252-824-7799
Practice Address - Street 1:1406 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-4152
Practice Address - Country:US
Practice Address - Phone:252-824-7700
Practice Address - Fax:252-824-7799
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC375213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890818UMedicaid
NC0818UOtherBCBS
NCU60495Medicare UPIN
NC2432944CMedicare ID - Type UnspecifiedMEDICARE