Provider Demographics
NPI:1073004966
Name:TAYLOR, KYLE MICHAEL
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:MICHAEL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5432 RATTLESNAKE HAMMOCK RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-7454
Mailing Address - Country:US
Mailing Address - Phone:239-784-4989
Mailing Address - Fax:
Practice Address - Street 1:5432 RATTLESNAKE HAMMOCK RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-7454
Practice Address - Country:US
Practice Address - Phone:239-784-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022214200Medicaid