Provider Demographics
NPI:1437171360
Name:BYERS, JONELL (M D)
Entity Type:Individual
Prefix:DR
First Name:JONELL
Middle Name:
Last Name:BYERS
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880-2134
Mailing Address - Country:US
Mailing Address - Phone:620-356-5665
Mailing Address - Fax:620-356-4744
Practice Address - Street 1:502 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2134
Practice Address - Country:US
Practice Address - Phone:620-356-5665
Practice Address - Fax:620-356-4744
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18229207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB91110Medicare UPIN
KS049039Medicare ID - Type Unspecified