MEDICARE: KENYANNA HEARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1568209724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYANNA HEARD

Provider Business Mailing Address
First Line	:	6314 FIRESTONE PKWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-1542
Country	:	US
Telephone Number	:	678-481-5410
Fax Number	:

Provider Business Practice Location Address
First Line	:	6314 FIRESTONE PKWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78244-1542
Country	:	US
Telephone Number	:	678-481-5410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2024
Last Update Date	:	07/13/2024

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Directions to “ KENYANNA HEARD ” Practice Location

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