Provider Demographics
NPI:1386983518
Name:INGLEDUE, KYLE HUGO
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:HUGO
Last Name:INGLEDUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 NORTH HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45830
Mailing Address - Country:US
Mailing Address - Phone:419-296-5003
Mailing Address - Fax:
Practice Address - Street 1:301 NORTH HIGH STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS GROVE
Practice Address - State:OH
Practice Address - Zip Code:45830
Practice Address - Country:US
Practice Address - Phone:419-296-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150693164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse