Provider Demographics
NPI:1588960694
Name:BEARD, KENNARD DAVID (PA)
Entity type:Individual
Prefix:
First Name:KENNARD
Middle Name:DAVID
Last Name:BEARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:440 DAVIS CT
Mailing Address - Street 2:APT 311
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-2445
Mailing Address - Country:US
Mailing Address - Phone:415-517-4047
Mailing Address - Fax:
Practice Address - Street 1:1990 N CALIFORNIA BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3742
Practice Address - Country:US
Practice Address - Phone:925-225-5837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20918363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical