Provider Demographics
NPI:1326029810
Name:PLUMMER, KYLEE VERLEE
Entity Type:Individual
Prefix:MS
First Name:KYLEE
Middle Name:VERLEE
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:VERLEE
Other - Last Name:SUTHERLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1075 STEVENSON AVE
Mailing Address - Street 2:PATTERSON ARMY HEALTH CLINIC
Mailing Address - City:FORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07703
Mailing Address - Country:US
Mailing Address - Phone:732-532-0182
Mailing Address - Fax:732-532-0194
Practice Address - Street 1:1075 STEVENSON AVE
Practice Address - Street 2:PATTERSON ARMY HEALTH CLINIC
Practice Address - City:FORT MONMOUTH
Practice Address - State:NJ
Practice Address - Zip Code:07703
Practice Address - Country:US
Practice Address - Phone:732-532-0182
Practice Address - Fax:732-532-0194
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00114729163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health