Provider Demographics
NPI:1467660910
Name:PAYNE, KYLE D (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:D
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 SAUNDERSVILLE RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8903
Mailing Address - Country:US
Mailing Address - Phone:901-203-2901
Mailing Address - Fax:901-779-6968
Practice Address - Street 1:176 BRIARWOOD ST STE B
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1456
Practice Address - Country:US
Practice Address - Phone:731-213-2720
Practice Address - Fax:731-350-0677
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49837207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1532333Medicaid
TN1532333Medicaid