Provider Demographics
NPI:1376130112
Name:KINARD, CARLEY TOMLINSON (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARLEY
Middle Name:TOMLINSON
Last Name:KINARD
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 CANNON ROAD
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31788
Mailing Address - Country:US
Mailing Address - Phone:229-873-5772
Mailing Address - Fax:
Practice Address - Street 1:2227 US HIGHWAY 41 N FL 3
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-2749
Practice Address - Country:US
Practice Address - Phone:229-353-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003257235Z00000X
GASLP011874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist