Healthcare Provider Details

I. General information

NPI: 1669002838
Provider Name (Legal Business Name): BRITTNEY GRACE KYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 NE 117TH ST STE 101
VANCOUVER WA
98686-4022
US

IV. Provider business mailing address

15309 NE 181ST ST UNIT A
BRUSH PRAIRIE WA
98606-9686
US

V. Phone/Fax

Practice location:
  • Phone: 360-566-9112
  • Fax:
Mailing address:
  • Phone: 360-721-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP60978805
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: