KYLE THOMAS DEIVERT
NPI 1922700301
Student in an Organized Health Care Education/Training Program in Jackson, MS

Active since March 20, 2023PECOS Enrolled
2500 N STATE ST, JACKSON, MS 39216(601) 984-1000 Get Directions Write a Review

NPPES record last updated: July 1, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jul 1, 2024, Jun 9, 2024, Mar 20, 2023 (3 updates tracked since 2023).

About Kyle Thomas Deivert NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KYLE THOMAS DEIVERT (NPI 1922700301) is an individual student in an organized health care education/training program in Jackson, Mississippi and active in the NPI registry since March 2023. He is enrolled in Medicare PECOS and maintains a secondary practice location in Winston Salem.

NPPES Registry Identity

NPI1922700301
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameKYLE THOMAS DEIVERT
Location Address2500 N STATE STJackson, MS 39216-4500
Mailing Address2500 N State StJackson, MS 39216-4500 · (601) 984-1000
Sole ProprietorYes
Enumeration DateMarch 20, 2023
Last NPPES UpdateJuly 1, 20243 updates tracked since enumeration
NPPES CertifiedJuly 1, 2024
NPI 1922700301 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Taxonomy Code390200000X
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Also ListedOrthopaedic SurgeryTaxonomy 207X00000X · License T-5207 (MS)
2500 N STATE ST, Jackson, MS 39216

Secondary Practice Location 1

Location 11 Medical Center BlvdWinston Salem, NC 27157-0001 · Phone (336) 716-0423

Medicare Participation & PECOS Enrollment Status

Kyle Deivert is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Durable Medical Equipment (DME) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

  • Is the provider registered in PECOS? Yes

  • Eligible to Order or Refer Part B Clinical Laboratory and Imaging: No

  • Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

  • Eligible to Order or Refer a Home Health Agency (HHA): No

  • Eligible to Order or Refer Power Mobility Devices: Yes

Other Providers at the Same Location


The following 20 providers are registered at the same or a nearby location.

Ophthalmology
2500 N STATE ST, STE B329
JACKSON, MS 39216
Pharmacist (Psychiatric)
2500 N STATE ST
JACKSON, MS 39216
Rehabilitation Unit
2500 N STATE ST
JACKSON, MS 39216
Otolaryngology
2500 N STATE ST, DEPARTMENT OF OTOLARYNGOLOGY
JACKSON, MS 39216
Dentist
2500 N STATE ST
JACKSON, MS 39216
Anesthesiology (Pediatric Anesthesiology)
2500 N STATE ST, DEPT. OF ANESTHESIOLOGY
JACKSON, MS 39216
Dentist
2500 N STATE ST, UNIVERSITY OF MISSISSIPPI SCHOOL OF DENTISTRY
JACKSON, MS 39216
Psychologist (Clinical)
2500 N STATE ST
JACKSON, MS 39216
Nurse Practitioner
2500 N STATE ST
JACKSON, MS 39216
Neurological Surgery
2500 N STATE ST, N703 NEUROSURGERY DEPARTMENT
JACKSON, MS 39216
Psychiatry & Neurology (Psychiatry)
2500 N STATE ST
JACKSON, MS 39216
Clinical Neuropsychologist
2500 N STATE ST
JACKSON, MS 39216
Psychologist (Clinical)
2500 N STATE ST
JACKSON, MS 39216
Medical Genetics (Clinical Genetics (M.D.))
2500 N STATE ST, DEPARTMENT OF PREVENTIVE MEDICINE
JACKSON, MS 39216
Clinical Medical Laboratory
2500 N STATE ST
JACKSON, MS 39216
Pediatrics (Pediatric Critical Care Medicine)
2500 N STATE ST
JACKSON, MS 39216
Pediatrics (Pediatric Critical Care Medicine)
2500 N STATE ST
JACKSON, MS 39216
Pediatrics (Pediatric Infectious Diseases)
2500 N STATE ST
JACKSON, MS 39216
Pediatrics
2500 N STATE ST
JACKSON, MS 39216
Pediatrics (Neonatal-Perinatal Medicine)
2500 N STATE ST
JACKSON, MS 39216

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1922700301, enumerated as an "individual" on March 20, 2023.

The provider is located at 2500 N STATE ST JACKSON, MS 39216 and the phone number is (601) 984-1000.

Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.