Kenneth Byrd, PA-C
Individual provider Active NPI Physician Assistant · Rogersville, TN
NPI 1497037550 · NPPES record last updated May 10, 2017
Key facts
- NPI
- 1497037550
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 2041 (TN)
- Practice address
- 312 Armstrong St
Rogersville, TN 37857-3606 - Phone
- (855) 933-6286
- Fax
- (865) 217-1094
- NPI assigned
- Sep 15, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111012000453 | TN | Practitioner - Physician Assistant | 7517139702 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2041 | TN | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Appalachian Orthopaedic Associates P C | Current |
Accepting new patients | |
| Wellmont Medical Associates, Inc. | Current |
Accepting new patients | |
| Appalachian Orthopaedic Associates P C | Current |
Accepting new patients | |
| Wellmont Medical Associates, Inc. | Current |
Accepting new patients | |
| Wellmont Physician Services Inc | Physician Assistant | Current |
Accepting new patients |
| Advanced Diagnostic Imaging, PC | Physician Assistant | Past | Accepting new patients |
Locations
260 Midway Medical Park
Ste 100
Bristol, TN 37620
Phone (423) 968-4446
1 Medical Park Blvd
Ste 300E
Bristol, TN 37620
Phone (423) 245-3161
105 Meadow View Rd
Ste 4
Bristol, TN 37620
Phone (423) 844-6935
401 Takoma Ave
Greeneville, TN 37743
Phone (423) 639-3151
3 Professional Park Dr
Ste 10
Johnson City, TN 37604
Phone (423) 926-4331
3 Professional Park Dr
Ste 21
Johnson City, TN 37604
111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197
105 W Stone Dr
Ste 6A
Kingsport, TN 37660
Phone (423) 408-7220
851 Locust St
Rogersville, TN 37857
Phone (423) 272-2671
Interoperability endpoints
- kenneth.byrd.1@1054.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2041 | TN | Yes |
Addresses
Primary practice location
312 Armstrong St
Rogersville, TN 37857-3606
Mailing address
3024 Business Park Cir
Goodlettsville, TN 37072-3132
Phone (615) 851-6033
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6094174 | Other | TN | BCBS OF TN |
| 1525628 | Medicaid | TN |
Other providers in Rogersville, TN
- Andrea Brooks
- Daniel Jaret Brooks
- Andrew Nathan Brown
- Shaloam Bryan
- Leslie Bumpas
- Rebecca R Byrd
- Christopher Lawrence Calendine
- Carewell Medical, LLC
- Jada Danielle Carpenter
- Kathy Loraine Carpenter
All providers in Rogersville, TN · Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 10, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.