Healthcare Provider Details

I. General information

NPI: 1447182142
Provider Name (Legal Business Name): KYLE RYAN CUNNINGHAM LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 LOW CT
FAIRFIELD CA
94534-9771
US

IV. Provider business mailing address

832 CRESTED DR
SUISUN CITY CA
94585-2172
US

V. Phone/Fax

Practice location:
  • Phone: 707-427-4900
  • Fax:
Mailing address:
  • Phone: 707-427-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number255120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: