Provider Demographics
NPI:1578633608
Name:KINARD, BENITA (NP)
Entity Type:Individual
Prefix:
First Name:BENITA
Middle Name:
Last Name:KINARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BENITA
Other - Middle Name:
Other - Last Name:KINARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP
Mailing Address - Street 1:50 GLEN ST
Mailing Address - Street 2:STE 107
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2701
Mailing Address - Country:US
Mailing Address - Phone:866-677-7622
Mailing Address - Fax:
Practice Address - Street 1:50 GLEN ST
Practice Address - Street 2:STE 107
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2701
Practice Address - Country:US
Practice Address - Phone:866-677-7622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner