Provider Demographics
NPI:1013084953
Name:BYRD, KATHRYN W (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:W
Last Name:BYRD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:W
Other - Last Name:BYRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6401 POPLAR AVE
Mailing Address - Street 2:SUITE 324
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4823
Mailing Address - Country:US
Mailing Address - Phone:901-681-9600
Mailing Address - Fax:901-681-9608
Practice Address - Street 1:6401 POPLAR AVE
Practice Address - Street 2:SUITE 324
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4823
Practice Address - Country:US
Practice Address - Phone:901-681-9600
Practice Address - Fax:901-681-9608
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20339207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3075062Medicaid
TN3075062Medicare ID - Type Unspecified
TN3075062Medicaid