Healthcare Provider Details

I. General information

NPI: 1609336510
Provider Name (Legal Business Name): KYLE SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9314 PARK WEST BLVD STE 400
KNOXVILLE TN
37923-4338
US

IV. Provider business mailing address

1932 ALCOA HWY STE 360
KNOXVILLE TN
37920-1509
US

V. Phone/Fax

Practice location:
  • Phone: 865-524-1869
  • Fax: 865-544-6533
Mailing address:
  • Phone: 865-524-1869
  • Fax: 865-544-6533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number62149
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number62149
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: