Provider Demographics
NPI:1275351306
Name:DOWNING, KYLIE MARIE
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:MARIE
Last Name:DOWNING
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 1:635 N EAST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3420
Mailing Address - Country:US
Mailing Address - Phone:626-537-6568
Mailing Address - Fax:
Practice Address - Street 1:1111 W GANSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4208
Practice Address - Country:US
Practice Address - Phone:810-584-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician