Provider Demographics
NPI:1265221956
Name:VANG, KYLIE KAY
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:KAY
Last Name:VANG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:KAY
Other - Last Name:SANDOVAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2301 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-2233
Mailing Address - Country:US
Mailing Address - Phone:580-641-2554
Mailing Address - Fax:
Practice Address - Street 1:2301 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2233
Practice Address - Country:US
Practice Address - Phone:580-641-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician