Provider Demographics
NPI:1487234613
Name:HAINES, KYLE ROBERT (LPN)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:ROBERT
Last Name:HAINES
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10196 STOREY GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-0086
Mailing Address - Country:US
Mailing Address - Phone:601-448-9675
Mailing Address - Fax:
Practice Address - Street 1:10196 STOREY GROVE WAY
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-0086
Practice Address - Country:US
Practice Address - Phone:601-448-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 174H00000X
FLPN5239135164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator