Healthcare Provider Details

I. General information

NPI: 1205414554
Provider Name (Legal Business Name): JOHN KYLE AMERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 CHESTNUT ST
MONTGOMERY AL
36106-1111
US

IV. Provider business mailing address

2034 CHESTNUT ST
MONTGOMERY AL
36106-1111
US

V. Phone/Fax

Practice location:
  • Phone: 334-531-9794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4716
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: