Provider Demographics
NPI:1376024950
Name:WHIPPLE, KYLIE MARIE
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:MARIE
Last Name:WHIPPLE
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 1:14621 TOMKI RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470-9735
Mailing Address - Country:US
Mailing Address - Phone:707-463-0405
Mailing Address - Fax:
Practice Address - Street 1:410 JONES ST STE C1
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5491
Practice Address - Country:US
Practice Address - Phone:707-463-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator