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General NPI Number Information
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NPI Number | 1487321766
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Entity Type | Individual
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Provider Name | TIARA KYLE
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Gender | Female
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Dates
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Enumeration Date | 08/25/2021
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 139 BOURBON ST
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City | FAIRMONT
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State | WV
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Zip | 26554-3066
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Country | US
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Telephone | 304-365-0901
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 431
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City | FAIRMONT
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State | WV
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Zip | 26555-0431
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Country | US
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Telephone | 304-216-4321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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