Provider Demographics
NPI:1063243459
Name:BEARD, KYRA
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2679 BEAU CT NW APT 3
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-1453
Mailing Address - Country:US
Mailing Address - Phone:330-805-3945
Mailing Address - Fax:
Practice Address - Street 1:2679 BEAU CT NW APT 3
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1453
Practice Address - Country:US
Practice Address - Phone:330-805-3945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services