Provider Demographics
NPI:1336647601
Name:KIRKPATRICK, KYLE LOGAN
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:LOGAN
Last Name:KIRKPATRICK
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 1:34 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-9106
Mailing Address - Country:US
Mailing Address - Phone:717-476-9440
Mailing Address - Fax:
Practice Address - Street 1:34 MAGNOLIA LN
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-9106
Practice Address - Country:US
Practice Address - Phone:717-476-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician