Provider Demographics
NPI:1225133978
Name:BATEMAN, KYLE SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:SCOTT
Last Name:BATEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KYLE
Other - Middle Name:SCOTT
Other - Last Name:BATEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:215 HWY 51 SOUTH
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-3245
Mailing Address - Country:US
Mailing Address - Phone:601-835-0650
Mailing Address - Fax:601-835-0610
Practice Address - Street 1:215 HWY 51 SOUTH
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-3245
Practice Address - Country:US
Practice Address - Phone:601-835-0650
Practice Address - Fax:601-835-0610
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00110157Medicaid
MS00110157Medicaid
MS0080001425Medicare ID - Type Unspecified