Provider Demographics
NPI:1932914397
Name:GYDESEN, KYLE HARLAN
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:HARLAN
Last Name:GYDESEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3544
Mailing Address - Country:US
Mailing Address - Phone:308-850-0892
Mailing Address - Fax:
Practice Address - Street 1:2419 W 11TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3544
Practice Address - Country:US
Practice Address - Phone:308-850-0892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion