Provider Demographics
NPI:1689851875
Name:KINNARD, SONYA
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:KINNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 HARRAH'S PWKY S EXT.
Mailing Address - Street 2:APT. #5101
Mailing Address - City:ROBINSONVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38664
Mailing Address - Country:US
Mailing Address - Phone:662-363-2961
Mailing Address - Fax:
Practice Address - Street 1:1970 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-7202
Practice Address - Country:US
Practice Address - Phone:662-624-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141211367500000X
TN078333367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered