Provider Demographics
NPI:1699407676
Name:ADRIANSON, KYLEE ANASTACIA
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:ANASTACIA
Last Name:ADRIANSON
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 1:817 E SOUTH H ST
Mailing Address - Street 2:
Mailing Address - City:GAS CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46933-2141
Mailing Address - Country:US
Mailing Address - Phone:765-667-4964
Mailing Address - Fax:
Practice Address - Street 1:817 E SOUTH H ST
Practice Address - Street 2:
Practice Address - City:GAS CITY
Practice Address - State:IN
Practice Address - Zip Code:46933-2141
Practice Address - Country:US
Practice Address - Phone:765-667-4964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer