Healthcare Provider Details

I. General information

NPI: 1154183432
Provider Name (Legal Business Name): KYLE AMAWI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/29/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 FRIARS POINT RD APT D
JACKSON TN
38305-5324
US

IV. Provider business mailing address

7 FRIARS POINT RD APT D
JACKSON TN
38305-5324
US

V. Phone/Fax

Practice location:
  • Phone: 832-891-1384
  • Fax:
Mailing address:
  • Phone: 832-891-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: