Provider Demographics
NPI:1124292768
Name:ACKER, KYLE N (AUD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:N
Last Name:ACKER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 BRYAN DAIRY RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1363
Mailing Address - Country:US
Mailing Address - Phone:727-398-5728
Mailing Address - Fax:
Practice Address - Street 1:8200 BRYAN DAIRY RD
Practice Address - Street 2:SUITE 340
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1363
Practice Address - Country:US
Practice Address - Phone:727-398-5728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK505ZMedicare PIN