Provider Demographics
NPI:1831667864
Name:SEYER, KYLIE B
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:B
Last Name:SEYER
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 1:121 PINECREST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-8465
Mailing Address - Country:US
Mailing Address - Phone:573-986-8109
Mailing Address - Fax:
Practice Address - Street 1:121 PINECREST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-8465
Practice Address - Country:US
Practice Address - Phone:573-986-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CSI797999868OtherBLUE CROSS BLUE SHIELD