Provider Demographics
NPI:1588489892
Name:DEMOSS, KYRA
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:DEMOSS
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 1:1211 BLAKE ST
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-2216
Mailing Address - Country:US
Mailing Address - Phone:304-962-3672
Mailing Address - Fax:
Practice Address - Street 1:1211 BLAKE ST
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-2216
Practice Address - Country:US
Practice Address - Phone:304-962-3672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency