Provider Demographics
NPI:1457970477
Name:KENNEDY, TYLER (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:KENNEDY
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 1:810 MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-2843
Mailing Address - Country:US
Mailing Address - Phone:615-223-5565
Mailing Address - Fax:615-223-5509
Practice Address - Street 1:810 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-2843
Practice Address - Country:US
Practice Address - Phone:615-223-5565
Practice Address - Fax:615-223-5509
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program