Provider Demographics
NPI:1184296220
Name:CAMPIE, KYLER (BS)
Entity type:Individual
Prefix:MR
First Name:KYLER
Middle Name:
Last Name:CAMPIE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 16TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-2328
Mailing Address - Country:US
Mailing Address - Phone:319-390-4611
Mailing Address - Fax:319-390-4381
Practice Address - Street 1:3601 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-2328
Practice Address - Country:US
Practice Address - Phone:319-390-4611
Practice Address - Fax:319-390-4381
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IA126163225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)