Provider Demographics
NPI:1699966309
Name:BYRD, KEVIN JAMES (QP)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JAMES
Last Name:BYRD
Suffix:
Gender:M
Credentials:QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1260 COLLEGE AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILKES
Mailing Address - State:NC
Mailing Address - Zip Code:28697
Mailing Address - Country:US
Mailing Address - Phone:336-667-5111
Mailing Address - Fax:336-667-0841
Practice Address - Street 1:1260 COLLEGE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2700
Practice Address - Country:US
Practice Address - Phone:336-667-5111
Practice Address - Fax:336-667-0841
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator