Provider Demographics
NPI:1043873227
Name:LYTLE, KELSEY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:LYTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 PIN OAK PARK APT 1117
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2286
Mailing Address - Country:US
Mailing Address - Phone:210-362-4551
Mailing Address - Fax:
Practice Address - Street 1:1313 21ST AVENUE S
Practice Address - Street 2:703 OXFORD HOUSE
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-4700
Practice Address - Country:US
Practice Address - Phone:615-936-0087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXT5164207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program