Provider Demographics
NPI:1316816317
Name:SAMPSON, KYLE WILLIAM (ND)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:WILLIAM
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 ROWLAND ST
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2684
Mailing Address - Country:US
Mailing Address - Phone:518-290-7599
Mailing Address - Fax:518-243-8325
Practice Address - Street 1:410 ROWLAND ST
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-2684
Practice Address - Country:US
Practice Address - Phone:518-290-7599
Practice Address - Fax:518-243-8325
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0990116348175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty