Provider Demographics
NPI:1225534027
Name:WYSS, KYLEY JO (MD)
Entity Type:Individual
Prefix:
First Name:KYLEY
Middle Name:JO
Last Name:WYSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KYLEY
Other - Middle Name:JO
Other - Last Name:MAXHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1163 W PEACHTREE ST NE APT 3007
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4550
Mailing Address - Country:US
Mailing Address - Phone:217-280-0573
Mailing Address - Fax:
Practice Address - Street 1:7777 HENNESSY BLVD STE 211
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4365
Practice Address - Country:US
Practice Address - Phone:225-765-7163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA327880207P00000X
390200000X
GA95628207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program