Provider Demographics
NPI:1417737396
Name:FOUCH, KYLE S (APRN)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:S
Last Name:FOUCH
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5010 N STONE MILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-9320
Mailing Address - Country:US
Mailing Address - Phone:812-929-7956
Mailing Address - Fax:888-789-8394
Practice Address - Street 1:501 S MADISON ST STE 105
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2452
Practice Address - Country:US
Practice Address - Phone:812-929-2193
Practice Address - Fax:888-789-8394
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28248377A163WP0808X
IN71014458A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health