Healthcare Provider Details

I. General information

NPI: 1164595013
Provider Name (Legal Business Name): KYLE AND ERIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 BOAT CLUB RD STE 114
FT WORTH TX
76135-7020
US

IV. Provider business mailing address

4516 BOAT CLUB RD STE 114
FT WORTH TX
76135-7020
US

V. Phone/Fax

Practice location:
  • Phone: 817-763-8040
  • Fax: 817-763-8043
Mailing address:
  • Phone: 817-763-8040
  • Fax: 817-763-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number80934
License Number StateTX

VIII. Authorized Official

Name: NANCY ANNE BUSH
Title or Position: OWNER
Credential:
Phone: 817-763-8040