Provider Demographics
NPI:1922065796
Name:WOMACK, KYLE BYRON (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:BYRON
Last Name:WOMACK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-1408
Mailing Address - Fax:314-286-1985
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV NEURO AGING AND DEMENTIA
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-1408
Practice Address - Fax:314-286-1985
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-04-25
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Provider Licenses
StateLicense IDTaxonomies
MO20200201192084B0040X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200085730Medicaid