Healthcare Provider Details

I. General information

NPI: 1285545335
Provider Name (Legal Business Name): KYLE ALLEN CANTWELL PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10368 WALLACE ALLEY ST STE 15
KINGSPORT TN
37663-3978
US

IV. Provider business mailing address

10368 WALLACE ALLEY ST STE 15
KINGSPORT TN
37663-3978
US

V. Phone/Fax

Practice location:
  • Phone: 423-530-3703
  • Fax: 423-500-7352
Mailing address:
  • Phone: 423-530-3703
  • Fax: 423-500-7342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number43234
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: