Provider Demographics
NPI:1104811850
Name:BYRD, KATHRYN S (DO)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:BYRD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3403
Mailing Address - Country:US
Mailing Address - Phone:817-912-9920
Mailing Address - Fax:817-912-9920
Practice Address - Street 1:5232 COLLEYVILLE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7826
Practice Address - Country:US
Practice Address - Phone:817-912-9920
Practice Address - Fax:817-912-9911
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148222604Medicaid
TX148222601Medicaid
TX148222605Medicaid
TX148222605Medicaid
G98240Medicare UPIN
TX148222601Medicaid
TX8K3089Medicare PIN