Provider Demographics
NPI:1235313099
Name:KINARD, LEVON
Entity Type:Individual
Prefix:MR
First Name:LEVON
Middle Name:
Last Name:KINARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 N JEFFERSON ST
Mailing Address - Street 2:P.O. BOX 656
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-9748
Mailing Address - Country:US
Mailing Address - Phone:662-448-1172
Mailing Address - Fax:
Practice Address - Street 1:678 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-9748
Practice Address - Country:US
Practice Address - Phone:662-448-1172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770566Medicaid