Provider Demographics
NPI:1578864336
Name:THOMPSON, KYLE G
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:G
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 W SAN JUAN ST APT A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8051
Mailing Address - Country:US
Mailing Address - Phone:727-809-3867
Mailing Address - Fax:
Practice Address - Street 1:3406 W SAN JUAN ST APT A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8051
Practice Address - Country:US
Practice Address - Phone:727-809-3867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health