Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Kyle Tackeberry

Individual provider Certified Registered Nurse Anesthetist · NPI 1558131631

Kyle Tackeberry is registered under Certified Registered Nurse Anesthetist (CRNA) in Charlotte, North Carolina. Licensed in South Carolina. Registered with an NPI since 2024.

Licensed in
SC
In the registry since
2024
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Practice location Address checks out

10628 Park Rd
Charlotte, NC 28210-8407
Phone: (704) 667-1000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 32130 (SC)

Record details

NPI number1558131631
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJanuary 8, 2024
Last updated in NPPESSeptember 1, 2026
Certification dateSeptember 1, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2026 (0 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician.

  • Atrium Health Pineville Hospital · Charlotte, NC

Other providers in Charlotte