Provider Demographics
NPI:1922073899
Name:KINARD, BRENDA SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:SUE
Last Name:KINARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:SUE
Other - Last Name:KINARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1955 1ST AVE N
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8941
Mailing Address - Country:US
Mailing Address - Phone:727-821-9997
Mailing Address - Fax:727-821-9011
Practice Address - Street 1:1955 1ST AVE N
Practice Address - Street 2:SUITE 103
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8941
Practice Address - Country:US
Practice Address - Phone:727-821-9997
Practice Address - Fax:727-821-9011
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050032174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE81513Medicare UPIN
FLK0645Medicare ID - Type UnspecifiedPROVIDER
FL11951ZMedicare ID - Type UnspecifiedPROVIDER NUMBER