Healthcare Provider Details

I. General information

NPI: 1912767534
Provider Name (Legal Business Name): MIAUNA KINNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3423 STONY SPRING CIR
LOUISVILLE KY
40220-5437
US

IV. Provider business mailing address

3423 STONY SPRING CIR
LOUISVILLE KY
40220-5437
US

V. Phone/Fax

Practice location:
  • Phone: 502-709-9589
  • Fax:
Mailing address:
  • Phone: 502-712-7443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: