Provider Demographics
NPI:1528733482
Name:KYLE, THERESA (APRN)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:KYLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8749 E FAIRWAY WOODS CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7438
Mailing Address - Country:US
Mailing Address - Phone:843-593-2038
Mailing Address - Fax:
Practice Address - Street 1:11000 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5732
Practice Address - Country:US
Practice Address - Phone:850-474-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9187464208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics