Provider Demographics
NPI:1083327126
Name:VALENTINE, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:VALENTINE
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 1:157 GREENGABLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4274
Mailing Address - Country:US
Mailing Address - Phone:757-803-6096
Mailing Address - Fax:
Practice Address - Street 1:1975 GLENN MITCHELL DR STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0167
Practice Address - Country:US
Practice Address - Phone:757-321-3300
Practice Address - Fax:757-321-3330
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110009355363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant