Provider Demographics
NPI:1962177543
Name:POOL, KYLIE (DCM, MAC, LAC)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:POOL
Suffix:
Gender:F
Credentials:DCM, MAC, LAC
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:GARLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DCM, MAC, LAC
Mailing Address - Street 1:5430 THREE POINTS BLVD APT 122
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-1141
Mailing Address - Country:US
Mailing Address - Phone:612-289-0153
Mailing Address - Fax:
Practice Address - Street 1:172 HAMEL RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:MN
Practice Address - Zip Code:55340-9535
Practice Address - Country:US
Practice Address - Phone:612-289-0153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-15
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1975171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty