Provider Demographics
NPI:1992462428
Name:KINNARD, EDWINA LYNN (RN)
Entity type:Individual
Prefix:
First Name:EDWINA
Middle Name:LYNN
Last Name:KINNARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11634 SAGEMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-5703
Mailing Address - Country:US
Mailing Address - Phone:765-513-4588
Mailing Address - Fax:
Practice Address - Street 1:11634 SAGEMEADOW LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-5703
Practice Address - Country:US
Practice Address - Phone:765-513-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX951921163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty