Provider Demographics
NPI:1477804995
Name:PYLE, JACQUELINE L (DPM)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:PYLE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 NE AKIN BLVD
Mailing Address - Street 2:APT 115
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-7936
Mailing Address - Country:US
Mailing Address - Phone:641-895-2895
Mailing Address - Fax:
Practice Address - Street 1:2406 E R D MIZE RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1808
Practice Address - Country:US
Practice Address - Phone:816-478-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015006726213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist