Provider Demographics
NPI:1225531098
Name:HALSOR, KYLA (MD)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:
Last Name:HALSOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 S VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3165
Mailing Address - Country:US
Mailing Address - Phone:575-526-7983
Mailing Address - Fax:575-526-7983
Practice Address - Street 1:1455 S VALLEY DR STE B
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3165
Practice Address - Country:US
Practice Address - Phone:755-526-6992
Practice Address - Fax:575-526-7983
Is Sole Proprietor?:No
Enumeration Date:2018-03-17
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61107798207Q00000X
NMMD2023-1308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine