Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 11071 | TN |
Y | 213EG0000X | General Practice | 11071 | TN |
NPI | 1003468232 |
---|---|
Provider Name | Kyle Humphrey |
First Address | Hendersonville, TN 37075-3492 |
Second Address | Hendersonville, TN 37075-3492 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2019 |
Last Update Date | 09/07/2019 |