Provider Demographics
NPI:1689025322
Name:ASHLAND, KYLE WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:WAYNE
Last Name:ASHLAND
Suffix:
Gender:M
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6909 PROSPERITY CHURCH RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6698
Practice Address - Country:US
Practice Address - Phone:704-384-1425
Practice Address - Fax:704-384-1426
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.069567207Q00000X
NC2020-00223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine