Provider Demographics
NPI:1053667857
Name:DURBIN, KYLE (HIS)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:DURBIN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 WHITE HILLS DR STE 400
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5516
Mailing Address - Country:US
Mailing Address - Phone:972-961-7177
Mailing Address - Fax:972-722-7772
Practice Address - Street 1:601 WHITE HILLS DR STE 400
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5516
Practice Address - Country:US
Practice Address - Phone:972-961-7177
Practice Address - Fax:972-722-7772
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50472237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist