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NPI Code Detail

MEDICARE: KYLE RICHARD NOWKA TCADC

MEDICARE: KYLE RICHARD NOWKA TCADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor245267KY

General Provider Information

NPI Number : 1831655307
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE RICHARD NOWKA TCADC
Provider Business Mailing Address
First Line : 635 MAXWELTON CT
Second Line :
City : LEXINGTON
State : KY
Zip : 40508-4012
Country : US
Telephone Number : 502-303-2980
Fax Number :
Provider Business Practice Location Address
First Line : 635 MAXWELTON CT
Second Line :
City : LEXINGTON
State : KY
Zip : 40508-4012
Country : US
Telephone Number : 502-303-2980
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2019
Last Update Date : 02/20/2019

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