Provider Demographics
NPI:1871268508
Name:DEAN, KYLIE ANN (ATC)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:ANN
Last Name:DEAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:KS
Mailing Address - Zip Code:67579-1725
Mailing Address - Country:US
Mailing Address - Phone:928-853-3722
Mailing Address - Fax:
Practice Address - Street 1:308 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:KS
Practice Address - Zip Code:67579-1725
Practice Address - Country:US
Practice Address - Phone:928-853-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-012492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer