Provider Demographics
NPI:1831487222
Name:WARD, KYLE A JR (DO)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:A
Last Name:WARD
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-4053
Mailing Address - Country:US
Mailing Address - Phone:276-679-5880
Mailing Address - Fax:276-679-6713
Practice Address - Street 1:105 W STONE DR
Practice Address - Street 2:SUITE 6A
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3365
Practice Address - Country:US
Practice Address - Phone:423-408-7220
Practice Address - Fax:423-408-7405
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVA033BMedicare PIN