Provider Demographics
NPI:1083492912
Name:KYLE, TIERRA (STNA)
Entity Type:Individual
Prefix:
First Name:TIERRA
Middle Name:
Last Name:KYLE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9803 MEMPHIS AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-2082
Mailing Address - Country:US
Mailing Address - Phone:216-400-1548
Mailing Address - Fax:
Practice Address - Street 1:9803 MEMPHIS AVE APT 7
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44144-2082
Practice Address - Country:US
Practice Address - Phone:216-400-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401989100717374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide