Provider Demographics
NPI:1912767534
Name:KINNARD, MIAUNA
Entity type:Individual
Prefix:
First Name:MIAUNA
Middle Name:
Last Name:KINNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 STONY SPRING CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5437
Mailing Address - Country:US
Mailing Address - Phone:502-712-7443
Mailing Address - Fax:
Practice Address - Street 1:3423 STONY SPRING CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-5437
Practice Address - Country:US
Practice Address - Phone:502-709-9589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 372600000X
KY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171400000XOther Service ProvidersHealth & Wellness Coach
No372600000XNursing Service Related ProvidersAdult Companion