Healthcare Provider Details

I. General information

NPI: 1326201856
Provider Name (Legal Business Name): KEVIN TYLER NASH MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 E GLENN AVE
AUBURN AL
36830-5998
US

IV. Provider business mailing address

1935 E GLENN AVE
AUBURN AL
36830-5998
US

V. Phone/Fax

Practice location:
  • Phone: 334-539-8049
  • Fax: 334-521-7454
Mailing address:
  • Phone: 334-539-8049
  • Fax: 334-521-7454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301092081
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number69316
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number33668
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number33668
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number33668
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: