Provider Demographics
NPI:1154809572
Name:MEYER, KYLIE
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 NW FLAGLER AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-1160
Mailing Address - Country:US
Mailing Address - Phone:859-250-6898
Mailing Address - Fax:859-212-9270
Practice Address - Street 1:275 NW FLAGLER AVE APT 401
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-1160
Practice Address - Country:US
Practice Address - Phone:859-250-6898
Practice Address - Fax:859-212-9270
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
KY265364221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional