Provider Demographics
NPI:1093203226
Name:STOUDER, KYLEE
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:STOUDER
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 1:17189 INTERSTATE 45 S STE 205
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3320
Mailing Address - Country:US
Mailing Address - Phone:936-270-4100
Mailing Address - Fax:936-270-4101
Practice Address - Street 1:17189 INTERSTATE 45 S STE 205
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-3320
Practice Address - Country:US
Practice Address - Phone:936-270-4100
Practice Address - Fax:936-270-4101
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT0010207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1093203226OtherNPI