Provider Demographics
NPI:1558863068
Name:MARTIN, KYLE LUCAS (APRN, FNP-C, ENP-C)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:LUCAS
Last Name:MARTIN
Suffix:
Gender:M
Credentials:APRN, FNP-C, ENP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S WEATHERRED DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-6021
Mailing Address - Country:US
Mailing Address - Phone:817-688-1769
Mailing Address - Fax:
Practice Address - Street 1:UT SOUTHWESTERN DEPARTMENT EMERGENCY MEDICINE
Practice Address - Street 2:5323 HARRY HINES BLVD
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-8579
Practice Address - Country:US
Practice Address - Phone:214-648-3916
Practice Address - Fax:214-648-8423
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX854402163W00000X
TXAP136590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse