Provider Demographics
NPI:1588549760
Name:KYLE HOLLIS OF CONCORD, PLLC
Entity type:Organization
Organization Name:KYLE HOLLIS OF CONCORD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYOR CONTRACTS
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-732-1504
Mailing Address - Street 1:9900 POPLAR TENT RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-9516
Mailing Address - Country:US
Mailing Address - Phone:704-782-2402
Mailing Address - Fax:
Practice Address - Street 1:9900 POPLAR TENT RD STE 150
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-9516
Practice Address - Country:US
Practice Address - Phone:704-782-2402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental