Provider Demographics
NPI:1972221372
Name:YECKLEY, KYLIE BROOKE (PA)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:BROOKE
Last Name:YECKLEY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1331 W GRAND PWKY N
Mailing Address - Street 2:SUITE 130
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 W GRAND PWKY N SUITE 130
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2711
Practice Address - Country:US
Practice Address - Phone:281-392-3401
Practice Address - Fax:281-392-7814
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2023-01-11
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant