Provider Demographics
NPI:1609849553
Name:BEARD, KIM L (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:L
Last Name:BEARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DAY LILY DR
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-5588
Mailing Address - Country:US
Mailing Address - Phone:662-312-5608
Mailing Address - Fax:
Practice Address - Street 1:101 DAY LILY DR
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-5588
Practice Address - Country:US
Practice Address - Phone:662-312-5608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR744768367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116259Medicaid
MS430000686Medicare PIN
MS00116259Medicaid