MEDICARE: KYLIE CHAMPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH27357	FL

General Provider Information

NPI Number	:	1952912834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE CHAMPA

Provider Business Mailing Address
First Line	:	96051 BASS LN
Second Line	:
City	:	YULEE
State	:	FL
Zip	:	32097-6593
Country	:	US
Telephone Number	:	954-495-5614
Fax Number	:

Provider Business Practice Location Address
First Line	:	1896 S 14TH ST
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-1999
Country	:	US
Telephone Number	:	904-310-9652
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	03/10/2026

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Directions to “ KYLIE CHAMPA ” Practice Location

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