Healthcare Provider Details

I. General information

NPI: 1518031699
Provider Name (Legal Business Name): KYLE STEVEN JOHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 S FORT AVE
SPRINGFIELD MO
65807-5196
US

IV. Provider business mailing address

2864 S NETTLETON AVE
SPRINGFIELD MO
65807-5970
US

V. Phone/Fax

Practice location:
  • Phone: 417-605-7100
  • Fax: 417-771-3723
Mailing address:
  • Phone: 417-874-1906
  • Fax: 417-771-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2000158907
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: