Provider Demographics
NPI:1326201856
Name:NASH, KEVIN TYLER (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:TYLER
Last Name:NASH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 CHAMPIONS BOUEVARD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6471
Mailing Address - Country:US
Mailing Address - Phone:334-539-8049
Mailing Address - Fax:334-521-7454
Practice Address - Street 1:2375 CHAMPIONS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6471
Practice Address - Country:US
Practice Address - Phone:334-539-8049
Practice Address - Fax:334-521-7454
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69316207N00000X
AL33668207N00000X
MI4301092081390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program