Kyle David Douglas, MSW

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

112 N Liberty St
Jackson, TN 38301-6200

Phone

(731) 736-4400

NPI assigned

Feb 3, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Positive Living Group

  • Community/Behavioral Health Agency
  • Jackson, TN
  • NPI 1336614130
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1699367409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 N LIBERTY ST",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383016200",
            "telephone_number": "731-736-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 N LIBERTY ST",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383016200",
            "telephone_number": "731-736-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "KYLE",
        "middle_name": "DAVID",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-03",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Jackson",
            "affiliation": "N",
            "endpointDescription": "Counseling",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "112 N Liberty St",
            "city": "Jackson",
            "state": "TN",
            "country_code": "US",
            "postal_code": "383016200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Doris Doss, CRISIS CLINICIAN
• Jake Hunter Doster, D.C.
• Christopher A Douglas, DC
• Hope Douglas, FNP
• Kelvin L. Douglas, M.D.
• Laquisha Douglas, MSN, APRN, PMHNP-BC
• Joshua Downey, DO
• Downtown Vision Center, P.C.
• Seth Doyle
• Dr Mark Lynn & Associates PLLC

• Social Worker in Jackson, TN
• Providers in Jackson, TN by specialty
• Social Worker in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.