Provider Demographics
NPI:1831650241
Name:KINARD, PHILLIP BERNARD
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:BERNARD
Last Name:KINARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 WALKING LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-9765
Mailing Address - Country:US
Mailing Address - Phone:202-834-1492
Mailing Address - Fax:
Practice Address - Street 1:433 WALKING LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-9765
Practice Address - Country:US
Practice Address - Phone:202-834-1492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCIHCP-1031OtherDHEC LICENSE