Provider Demographics
NPI:1699571034
Name:HENDRIX, KYLE JAMES (RN, CCM)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:JAMES
Last Name:HENDRIX
Suffix:
Gender:
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-4016
Mailing Address - Country:US
Mailing Address - Phone:805-709-1391
Mailing Address - Fax:925-278-7157
Practice Address - Street 1:106 SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-4016
Practice Address - Country:US
Practice Address - Phone:805-709-1391
Practice Address - Fax:925-278-7157
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1006321163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management