Provider Demographics
NPI:1639327125
Name:BEAVERS, KYNDAL ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KYNDAL
Middle Name:ANN
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EDGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4337
Mailing Address - Country:US
Mailing Address - Phone:276-223-0558
Mailing Address - Fax:
Practice Address - Street 1:100 EDGEMONT RD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-4337
Practice Address - Country:US
Practice Address - Phone:276-223-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine