Provider Demographics
NPI:1639699697
Name:KYLES, THOMAS DESHAWN JR
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DESHAWN
Last Name:KYLES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:DESHAWN
Other - Last Name:KYLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3829 LAKEHURST DR APT 204
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-3419
Mailing Address - Country:US
Mailing Address - Phone:773-875-4417
Mailing Address - Fax:
Practice Address - Street 1:3829 LAKEHURST DR APT 204
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-3419
Practice Address - Country:US
Practice Address - Phone:773-875-4417
Practice Address - Fax:773-875-4417
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)