MEDICARE: MR. KYLE W E OSBORN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215227061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KYLE W E OSBORN

Provider Business Mailing Address
First Line	:	11153 VERISMO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3442
Country	:	US
Telephone Number	:	702-525-1636
Fax Number	:

Provider Business Practice Location Address
First Line	:	2980 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5656
Country	:	US
Telephone Number	:	702-319-1555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	04/14/2011

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Directions to “ MR. KYLE W E OSBORN ” Practice Location

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