Healthcare Provider Details

I. General information

NPI: 1750061917
Provider Name (Legal Business Name): KYLIE LYNN KRETZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 DELCO PARK DR
DAYTON OH
45420-1398
US

IV. Provider business mailing address

3000 SONOMA BLVD
SCHERTZ TX
78154-2096
US

V. Phone/Fax

Practice location:
  • Phone: 937-299-2339
  • Fax: 800-587-5027
Mailing address:
  • Phone: 570-956-5042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1151214
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAPRN.CNP.0028452
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: