Provider Demographics
NPI:1811620396
Name:BALDON, KYLIE SORAI
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:SORAI
Last Name:BALDON
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 1:5713 EADS ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6922
Mailing Address - Country:US
Mailing Address - Phone:202-427-6413
Mailing Address - Fax:
Practice Address - Street 1:1821 T ST NW APT 302
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-7141
Practice Address - Country:US
Practice Address - Phone:202-826-1349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide