Provider Demographics
NPI:1205803384
Name:KINNARD, CHERYL (PA-C)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:KINNARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:BOEHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5755 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2912
Mailing Address - Country:US
Mailing Address - Phone:410-884-4746
Mailing Address - Fax:410-884-4746
Practice Address - Street 1:5755 CEDAR LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2999
Practice Address - Country:US
Practice Address - Phone:410-884-4746
Practice Address - Fax:410-884-4749
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105332363A00000X
MDC0001619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S59207Medicare UPIN
MD568LL204Medicare ID - Type Unspecified