Healthcare Provider Details

I. General information

NPI: 1891737243
Provider Name (Legal Business Name): KYLE DALE NEVILLS CRNA, DNP, NSPM-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 HYLTON HEIGHTS RD STE 109
MANHATTAN KS
66502
US

IV. Provider business mailing address

1213 HYLTON HEIGHTS RD STE 109
MANHATTAN KS
66502-2812
US

V. Phone/Fax

Practice location:
  • Phone: 785-320-7576
  • Fax: 785-320-5428
Mailing address:
  • Phone: 785-320-7576
  • Fax: 785-320-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number54321
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54321
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: