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General NPI Number Information
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NPI Number | 1205803384
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Entity Type | Individual
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Provider Name | CHERYL KINNARD PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 12/07/2018
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Provider Practice Location Address
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Address Line | 5755 CEDAR LN
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City | COLUMBIA
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State | MD
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Zip | 21044-2999
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Country | US
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Telephone | 410-884-4746
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Fax | 410-884-4749
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Provider Business Mailing Address
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Address Line | 5755 CEDAR LN
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City | COLUMBIA
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State | MD
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Zip | 21044-2912
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Country | US
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Telephone | 410-884-4746
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Fax | 410-884-4746
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9105332
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0001619
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License Number State | MD
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