| Provider / Organization | NPI | Date Certified |
|---|---|---|
| KYLE THOMAS DEIVERT | 1922700301 | 2024-06-09 |
Kyle Thomas Deivert is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1922700301. Registration indicates Kyle Thomas Deivert is a provider of services with a specialization in Student, Health Care, Student in an Organized Health Care Education/Training Program (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care)
| Entity Type | Individual |
| Provider Name | Kyle Thomas Deivert |
| Practice Office Address | 2500 N STATE ST JACKSON, MS US |
| Practice Office Telephone | 6019841000 |
| Mailing Address | 2500 N STATE ST JACKSON, MS 392164500 US |
| Business Telephone | 6019841000 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 1 Medical Center Blvd | Winston Salem, NC 271570001 | 3367160423 |
| Code | Practice | License No State |
|---|---|---|
| 390200000X PRIMARY | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care |