Provider Demographics
NPI:1508007436
Name:SETTLES, KEVIN C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:C
Last Name:SETTLES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:AL
Mailing Address - Zip Code:36053-0217
Mailing Address - Country:US
Mailing Address - Phone:626-404-6555
Mailing Address - Fax:
Practice Address - Street 1:119 BOONE RIDGE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-4998
Practice Address - Country:US
Practice Address - Phone:423-282-1480
Practice Address - Fax:423-928-1353
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK669103TC0700X
AL1984103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM320070Medicare Oscar/Certification
NMH3451Medicaid