Provider Demographics
NPI:1831125020
Name:BYARD, KELLY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:BYARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 AVENTURA BLVD
Mailing Address - Street 2:S. 205
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3124
Mailing Address - Country:US
Mailing Address - Phone:305-933-6716
Mailing Address - Fax:
Practice Address - Street 1:2925 AVENTURA BLVD
Practice Address - Street 2:S. 205
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3124
Practice Address - Country:US
Practice Address - Phone:305-933-6716
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant