Healthcare Provider Details

I. General information

NPI: 1043873227
Provider Name (Legal Business Name): KELSEY LYNN LYTLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 21ST AVENUE S 703 OXFORD HOUSE
NASHVILLE TN
37232-4700
US

IV. Provider business mailing address

4848 PIN OAK PARK APT 1117
HOUSTON TX
77081-2286
US

V. Phone/Fax

Practice location:
  • Phone: 615-936-0087
  • Fax:
Mailing address:
  • Phone: 210-362-4551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT5164
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: