Provider Demographics
NPI:1427376995
Name:KYDE, MICHAEL A (LPN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:KYDE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-0145
Mailing Address - Country:US
Mailing Address - Phone:614-561-8344
Mailing Address - Fax:614-245-4128
Practice Address - Street 1:4818 INDIANOLA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1823
Practice Address - Country:US
Practice Address - Phone:614-430-3711
Practice Address - Fax:614-245-4128
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-09
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH139627164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse