Individual
KYLE J DICKALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
130 W RAVINE RD, KINGSPORT, TN 37660-3837
(423) 224-4000
Mailing address
284 CHESTERFIELD DR, KINGSPORT, TN 37663-2976
(615) 604-6390
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
198328
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
27200
TN
Other
Enumeration date
10/03/2019
Last updated
02/24/2020
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