Provider Demographics
NPI:1992422125
Name:BROWN, KYLIE ANGALINE
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:ANGALINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:ANGALINE
Other - Last Name:PYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1737
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-4737
Mailing Address - Country:US
Mailing Address - Phone:304-822-3838
Mailing Address - Fax:304-822-7140
Practice Address - Street 1:22347 NORTHWESTERN PIKE
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-6343
Practice Address - Country:US
Practice Address - Phone:304-822-3838
Practice Address - Fax:304-822-7140
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV184OtherTEMP PERMIT #