Provider Demographics
NPI:1114525284
Name:WARNICK, KYLA
Entity Type:Individual
Prefix:DR
First Name:KYLA
Middle Name:
Last Name:WARNICK
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 1:1705 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-9072
Mailing Address - Country:US
Mailing Address - Phone:479-857-5036
Mailing Address - Fax:
Practice Address - Street 1:1310 W B ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2802
Practice Address - Country:US
Practice Address - Phone:479-857-5036
Practice Address - Fax:479-974-2010
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist