Provider Demographics
NPI:1184410904
Name:BYRD, JOHNNY PAUL JR
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:PAUL
Last Name:BYRD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HIGHWAY 3091 APT A
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-5703
Mailing Address - Country:US
Mailing Address - Phone:606-594-9096
Mailing Address - Fax:
Practice Address - Street 1:204 HIGHWAY 3091 APT A
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-5703
Practice Address - Country:US
Practice Address - Phone:606-594-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program