Provider Demographics
NPI:1922660372
Name:BUONGIORNE, KYLIE ROSE
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:ROSE
Last Name:BUONGIORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:ROSE
Other - Last Name:WYCKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:904 PRINCESS ANNE ST STE 407
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5804
Mailing Address - Country:US
Mailing Address - Phone:540-479-3889
Mailing Address - Fax:540-479-3946
Practice Address - Street 1:904 PRINCESS ANNE ST STE 407
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5804
Practice Address - Country:US
Practice Address - Phone:540-479-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-06
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133003142103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst