Provider Demographics
NPI:1225612955
Name:RADEK, KYLIE DANIELLE
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:DANIELLE
Last Name:RADEK
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 1:548 SINKING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-6904
Mailing Address - Country:US
Mailing Address - Phone:865-438-8418
Mailing Address - Fax:865-498-0350
Practice Address - Street 1:548 SINKING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-6904
Practice Address - Country:US
Practice Address - Phone:865-438-8418
Practice Address - Fax:865-498-0350
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-09
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide