Healthcare Provider Details

I. General information

NPI: 1689851875
Provider Name (Legal Business Name): SONYA KINNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 HOSPITAL DR
CLARKSDALE MS
38614-7202
US

IV. Provider business mailing address

1632 HARRAH'S PWKY S EXT. APT. #5101
ROBINSONVILLE MS
38664
US

V. Phone/Fax

Practice location:
  • Phone: 662-624-3211
  • Fax:
Mailing address:
  • Phone: 662-363-2961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP141211
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number078333
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: