Provider Demographics
NPI:1023577467
Name:LYTLE, KAY
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:LYTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 879455
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-9455
Mailing Address - Country:US
Mailing Address - Phone:907-262-0893
Mailing Address - Fax:907-262-0891
Practice Address - Street 1:33880 COMMUNITY COLLEGE DR STE 1
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-9234
Practice Address - Country:US
Practice Address - Phone:907-262-0893
Practice Address - Fax:907-262-0891
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician