=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730087057
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYLIE LAYNE RDMS (ABD,OB/GYN)RVT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2026
-----------------------------------------------------
Last Update Date | 10/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 SYDNEY BLVD
-----------------------------------------------------
City | THORNDALE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76577-5432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-430-0546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 610 MILLER ST
-----------------------------------------------------
City | ROCKDALE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76567-2265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-430-0546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085U0001X
-----------------------------------------------------
Taxonomy Name | Diagnostic Ultrasound Physician
-----------------------------------------------------
License Number | 271895
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------