Provider Demographics
NPI:1003673195
Name:EASTMAN, KYLIA (CIT)
Entity Type:Individual
Prefix:
First Name:KYLIA
Middle Name:
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3045
Mailing Address - Country:US
Mailing Address - Phone:479-395-1599
Mailing Address - Fax:
Practice Address - Street 1:3811 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3045
Practice Address - Country:US
Practice Address - Phone:479-395-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health