Provider Demographics
NPI:1518031699
Name:JOHN, KYLE STEVEN (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:STEVEN
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2864 S NETTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5970
Mailing Address - Country:US
Mailing Address - Phone:417-874-1906
Mailing Address - Fax:417-771-3723
Practice Address - Street 1:3023 S FORT AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5196
Practice Address - Country:US
Practice Address - Phone:417-605-7100
Practice Address - Fax:417-771-3723
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001589072084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1518031699Medicaid
ARNP0487800Medicaid
OK100178800AMedicaid
MOP00700779OtherRAILROAD MEDICARE