Provider Demographics
NPI:1679445761
Name:UNNOPPET, KYLEE SHAY
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:SHAY
Last Name:UNNOPPET
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 1:2816 HANCOCK ST NE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-4502
Mailing Address - Country:US
Mailing Address - Phone:757-846-3834
Mailing Address - Fax:
Practice Address - Street 1:2816 HANCOCK ST NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-4502
Practice Address - Country:US
Practice Address - Phone:757-846-3834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB61703803363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant