Healthcare Provider Details

I. General information

NPI: 1437790771
Provider Name (Legal Business Name): KYLE JAMES BEELER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVE
FORT BRAGG NC
28310-4138
US

IV. Provider business mailing address

7 CARMEL VLY
COTO DE CAZA CA
92679-4739
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-6036
  • Fax:
Mailing address:
  • Phone: 949-609-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: