Provider Demographics
NPI:1992737530
Name:BEARD, KENYA (NP EDD)
Entity type:Individual
Prefix:DR
First Name:KENYA
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:NP EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PINE HILL LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6526
Mailing Address - Country:US
Mailing Address - Phone:631-278-3805
Mailing Address - Fax:
Practice Address - Street 1:16 PINE HILL LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6526
Practice Address - Country:US
Practice Address - Phone:631-278-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304135363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner