Provider Demographics
NPI:1730313115
Name:KINNARD, REBECCA JOHNSON (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOHNSON
Last Name:KINNARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:GERALYN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3087
Mailing Address - Street 2:CREDENTIALING
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-3087
Mailing Address - Country:US
Mailing Address - Phone:985-230-1682
Mailing Address - Fax:985-230-6652
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-345-2700
Practice Address - Fax:985-230-2159
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205518207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology