Provider Demographics
NPI:1407323454
Name:BEARD, KEARA KENYATTA (BA)
Entity type:Individual
Prefix:
First Name:KEARA
Middle Name:KENYATTA
Last Name:BEARD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 PERKINS ROAD
Mailing Address - Street 2:APT. 1119
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808
Mailing Address - Country:US
Mailing Address - Phone:225-485-1481
Mailing Address - Fax:
Practice Address - Street 1:4348 JEFFERY DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70874-7087
Practice Address - Country:US
Practice Address - Phone:225-239-9633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator