Provider Demographics
NPI:1467742221
Name:MAYO, KIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRA
Middle Name:
Last Name:MAYO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GLIDEPATH WAY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-4133
Mailing Address - Country:US
Mailing Address - Phone:615-449-5771
Mailing Address - Fax:615-449-5740
Practice Address - Street 1:5073 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2738
Practice Address - Country:US
Practice Address - Phone:931-451-0483
Practice Address - Fax:615-900-2249
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN62845207N00000X
NY248038207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology