Provider Demographics
NPI:1396622007
Name:MORALES, KYLIL ABRAHAM
Entity type:Individual
Prefix:
First Name:KYLIL
Middle Name:ABRAHAM
Last Name:MORALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 NW 111TH CT
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052-2510
Mailing Address - Country:US
Mailing Address - Phone:215-876-7304
Mailing Address - Fax:
Practice Address - Street 1:3111 NW 111TH CT
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:FL
Practice Address - Zip Code:32052-2510
Practice Address - Country:US
Practice Address - Phone:215-876-7304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA40970171400000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty