Provider Demographics
NPI:1770854366
Name:BYERLY, KITARA M
Entity Type:Individual
Prefix:
First Name:KITARA
Middle Name:M
Last Name:BYERLY
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 1:1706 OLIVE ST APT B
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-8170
Mailing Address - Country:US
Mailing Address - Phone:512-851-3303
Mailing Address - Fax:
Practice Address - Street 1:1706 OLIVE ST APT B
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-8170
Practice Address - Country:US
Practice Address - Phone:512-851-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC#01254171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist