Provider Demographics
NPI:1083369003
Name:LEDESMA, KYLEA MICHAEL
Entity Type:Individual
Prefix:
First Name:KYLEA
Middle Name:MICHAEL
Last Name:LEDESMA
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 1:1408 PARK ST
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-2661
Mailing Address - Country:US
Mailing Address - Phone:712-299-3573
Mailing Address - Fax:
Practice Address - Street 1:201 ONEIDA ST
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-2545
Practice Address - Country:US
Practice Address - Phone:712-732-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide