Healthcare Provider Details

I. General information

NPI: 1083368583
Provider Name (Legal Business Name): KIYA BEARD EMT, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8502 BROOKVILLE RD # 9
INDIANAPOLIS IN
46239-9427
US

IV. Provider business mailing address

8502 BROOKVILLE RD # 9
INDIANAPOLIS IN
46239-9427
US

V. Phone/Fax

Practice location:
  • Phone: 317-914-7075
  • Fax:
Mailing address:
  • Phone: 317-914-7075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number4600-5674-5551
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: