Provider Demographics
NPI:1649767369
Name:GABRIELSON, KYLE PATRICK
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:PATRICK
Last Name:GABRIELSON
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 1:1 UNIVERSITY AVE # 4259
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-1098
Mailing Address - Country:US
Mailing Address - Phone:316-204-7606
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY AVE # 4259
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-1098
Practice Address - Country:US
Practice Address - Phone:316-204-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer