Healthcare Provider Details

I. General information

NPI: 1720724248
Provider Name (Legal Business Name): KYLIE BYRD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2022
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

III MEF FORCE SURGEON UNIT 35605
FPO AP
96382
US

IV. Provider business mailing address

III MEF FORCE SURGEON UNIT 35605
FPO AP
96382
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-2339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101279689
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: