Provider Demographics
NPI:1598236341
Name:WENDER, KYLE (ATP)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:WENDER
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 N LAURENT ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4132
Mailing Address - Country:US
Mailing Address - Phone:361-485-2000
Mailing Address - Fax:361-485-2005
Practice Address - Street 1:2517 N LAURENT ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-4132
Practice Address - Country:US
Practice Address - Phone:361-485-2000
Practice Address - Fax:361-485-2005
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74459246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other