Provider Demographics
NPI:1164026142
Name:KNORE, KYLE WELLS
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:WELLS
Last Name:KNORE
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 1:2139 BENNETT SCHOOL HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-8358
Mailing Address - Country:US
Mailing Address - Phone:740-285-0185
Mailing Address - Fax:
Practice Address - Street 1:2139 BENNETT SCHOOL HOUSE RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-8358
Practice Address - Country:US
Practice Address - Phone:740-285-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider