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General NPI Number Information
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NPI Number | 1497037550
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Entity Type | Individual
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Provider Name | KENNETH BYRD PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 312 ARMSTRONG ST
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City | ROGERSVILLE
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State | TN
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Zip | 37857-3606
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Country | US
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Telephone | 855-933-6286
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Fax | 865-217-1094
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Provider Business Mailing Address
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Address Line | 3024 BUSINESS PARK CIR
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072-3132
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Country | US
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Telephone | 615-851-6033
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Fax | 615-296-9937
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2041
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License Number State | TN
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