Provider Demographics
NPI:1669002838
Name:KYLE, BRITTNEY GRACE
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:GRACE
Last Name:KYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15309 NE 181ST ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-9686
Mailing Address - Country:US
Mailing Address - Phone:360-721-2703
Mailing Address - Fax:
Practice Address - Street 1:2009 NE 117TH ST STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-4022
Practice Address - Country:US
Practice Address - Phone:360-566-9112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60978805164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse