Provider Demographics
NPI:1760236459
Name:WADE, KYLE LAMONT
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:LAMONT
Last Name:WADE
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 1:6719 JENNYANN WAY
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8635
Mailing Address - Country:US
Mailing Address - Phone:614-999-5817
Mailing Address - Fax:
Practice Address - Street 1:6719 JENNYANN WAY
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8635
Practice Address - Country:US
Practice Address - Phone:614-999-5817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide