Kyle Phillip Radack (NPI# 1154663672, PAC ID# 5698047264) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DERMATOLOGY.
| Nation Provider ID (NPI) | 1154663672 |
| PAC ID by PECOS | 5698047264 |
| Professional Enrollment ID | I20170816002164 |
| Full Name | Kyle Phillip Radack |
| Organization Legal Name | DERMATOLOGY ASSOCIATES OF KINGSPORT, P.C. |
| Address |
3183 W State St Bristol TN 37620-1712 |
| Phone Number | 4237647131 |
| Gender | M |
| Medical School | MEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE |
| Graduation Year | 2013 |
| Primary Specialty | DERMATOLOGY |
| Group Practice PAC ID | 3971578816 |
| Number of Group Practice Members | 20 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 490053 | JOHNSTON MEMORIAL HOSPITAL |
| 440012 | WELLMONT BRISTOL REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 3183 W State St, Bristol, TN 37620-1712 | 4237647131 | DERMATOLOGY ASSOCIATES OF KINGSPORT, P.C. |
| 2300 W Stone Dr, Kingsport, TN 37660-2360 | 4232464961 | DERMATOLOGY ASSOCIATES OF KINGSPORT, P.C. |
| Organization Legal Name | DERMATOLOGY ASSOCIATES OF KINGSPORT, P.C. |
| Physicians | 21 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Lillian Amber Mccall | Nurse Practitioner | Dermatology Associates of Kingsport, P.C. | 2885 Boones Creek Rd, Johnson City, TN 37615-4661 |
| Holly A Sanders | Dermatology | Dermatology Associates of Kingsport, P.C. | 1021 W Oakland Ave, Suite 102, Johnson City, TN 37604-2192 |
| Shelley Hilton | Nurse Practitioner | Dermatology Associates of Kingsport, P.C. | 2300 W Stone Dr, Kingsport, TN 37660-2360 |
| Julia Erin Reid | Dermatology | Dermatology Associates of Kingsport, P.C. | 3183 W State St, Bristol, TN 37620-1712 |
| James Patrick Rash | Dermatology | Dermatology Associates of Kingsport, P.C. | 3183 W State St, Bristol, TN 37620-1712 |
| Jennifer M Barham | Nurse Practitioner | Dermatology Associates of Kingsport, P.C. | 3183 W State St, Bristol, TN 37620-1712 |
| Allison M Pierce | Dermatology | Dermatology Associates of Kingsport, P.C. | 3183 W State St, Bristol, TN 37620-1712 |
| Chadwick J Thomas | Dermatology | Dermatology Associates of Kingsport, P.C. | 2885 Boones Creek Rd, Johnson City, TN 37615-4661 |
| Hannah Ruth Cook | Physician Assistant | Dermatology Associates of Kingsport, P.C. | 2300 W Stone Dr, Kingsport, TN 37660-2360 |
| Carri Beth Homoky | Dermatology | Dermatology Associates of Kingsport, P.C. | 2300 W Stone Dr, Kingsport, TN 37660-2360 |
| Street Address |
3183 W STATE ST |
| City | BRISTOL |
| State | TN |
| Zip | 37620-1712 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Claudia F Corradino | Nurse Practitioner | Wellmont Medical Associates Inc | 3183 W State St, Suite 1101, Bristol, TN 37620-1713 |
| Julia Erin Reid | Dermatology | Dermatology Associates of Kingsport, P.C. | 3183 W State St, Bristol, TN 37620-1712 |
| James Patrick Rash | Dermatology | Dermatology Associates of Kingsport, P.C. | 3183 W State St, Bristol, TN 37620-1712 |
| Jennifer M Barham | Nurse Practitioner | Dermatology Associates of Kingsport, P.C. | 3183 W State St, Bristol, TN 37620-1712 |
| Allison M Pierce | Dermatology | Dermatology Associates of Kingsport, P.C. | 3183 W State St, Bristol, TN 37620-1712 |
| Shawn K Nelson | Neurology | Wellmont Medical Associates Inc | 3183 W State St, Bristol, TN 37620-1713 |
| Douglas P Williams | Neurology | Wellmont Medical Associates Inc | 3183 W State St, Bristol, TN 37620-1713 |
| Ashley D Pierson | Physician Assistant | Dermatology Associates of Kingsport, P.C. | 3183 W State St, Bristol, TN 37620-1712 |
| Kara Marie Hill | Nurse Practitioner | Wellmont Medical Associates Inc | 3183 W State St, Suite 1201, Bristol, TN 37620-1713 |
| Sharman Denise Whitfield | Nurse Practitioner | Dermatology Associates of Kingsport, P.C. | 3183 W State St, Bristol, TN 37620-1712 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Scott Fowler | Obstetrics/gynecology | Holston Medical Group PC | 320 Bristol W Blvd, Suite 2c, Bristol, TN 37620 |
| Tara D Spurling | Nurse Practitioner | Holston Medical Group PC | 320 Bristol W Blvd, Suite 2c, Bristol, TN 37620 |
| Stacie L Mccray | Nurse Practitioner | Holston Medical Group PC | 320 Bristol W Blvd, Suite 2c, Bristol, TN 37620 |
| Cynthia L Mcglothlin | Nurse Practitioner | Holston Medical Group PC | 320 Bristol W Blvd, Suite 2c, Bristol, TN 37620 |
| Nyela Aldridge Edwards | Certified Nurse Midwife (cnm) | Holston Medical Group PC | 320 Bristol W Blvd, Suite 2c, Bristol, TN 37620 |
| Jeffrey A Mcqueary | Obstetrics/gynecology | Holston Medical Group PC | 320 Bristol W Blvd, Suite 2c, Bristol, TN 37620 |
| Autumn R Hoover | Nurse Practitioner | Holston Medical Group PC | 320 Bristol W Blvd, Suite 2c, Bristol, TN 37620 |
| Alyssa Nicole Phelps | Obstetrics/gynecology | Holston Medical Group PC | 320 Bristol W Blvd, Suite 2c, Bristol, TN 37620 |
| Jeffrey R Looney | Obstetrics/gynecology | Holston Medical Group PC | 320 Bristol W Blvd, Suite 2c, Bristol, TN 37620 |
| Lynn H Couch | Certified Registered Nurse Anesthetist (crna) | Innovative Surgical Solutions, Pllc | 3185 W State St, Suite 2020, Bristol, TN 37620-1600 |
| Find all physicians in zip 37620 | |||
| City | BRISTOL |
| Zip Code | 37620 |
| Specialty | DERMATOLOGY |
| City + Specialty | BRISTOL + DERMATOLOGY |
Please comment or provide details below to improve the information on Kyle Phillip Radack.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.