Healthcare Provider Details

I. General information

NPI: 1376077883
Provider Name (Legal Business Name): KYLER BLAINE FOLSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 KALISTE SALOOM RD
LAFAYETTE LA
70508-5705
US

IV. Provider business mailing address

108 CASCADE RD
RAYNE LA
70578-2543
US

V. Phone/Fax

Practice location:
  • Phone: 337-366-7535
  • Fax:
Mailing address:
  • Phone: 337-366-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: