Provider Demographics
NPI:1083240618
Name:PADGETT, PATRICIA KYL
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KYL
Last Name:PADGETT
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 1:3206 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-2951
Mailing Address - Country:US
Mailing Address - Phone:334-768-2181
Mailing Address - Fax:334-768-2185
Practice Address - Street 1:3206 20TH AVE
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-2951
Practice Address - Country:US
Practice Address - Phone:334-768-2181
Practice Address - Fax:334-768-2185
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0603261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center