Provider Demographics
NPI:1083368583
Name:BEARD, KIYA (EMT, CPT)
Entity Type:Individual
Prefix:
First Name:KIYA
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:EMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8502 BROOKVILLE RD # 9
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-9427
Mailing Address - Country:US
Mailing Address - Phone:317-914-7075
Mailing Address - Fax:
Practice Address - Street 1:8502 BROOKVILLE RD # 9
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-9427
Practice Address - Country:US
Practice Address - Phone:317-914-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN4600-5674-5551146N00000X
IN246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty