Provider Demographics
NPI:1093195398
Name:CORRELL, KYLE NATHANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:NATHANIEL
Last Name:CORRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2744
Mailing Address - Country:US
Mailing Address - Phone:386-238-3242
Mailing Address - Fax:386-238-3223
Practice Address - Street 1:320 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2744
Practice Address - Country:US
Practice Address - Phone:386-238-3242
Practice Address - Fax:386-238-3223
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130000207RS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine