Provider Demographics
NPI:1467247742
Name:LINES, KYLE (BS, RN, CEN, CPEN)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:LINES
Suffix:
Gender:
Credentials:BS, RN, CEN, CPEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 N ELOISA LN
Mailing Address - Street 2:
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552-5579
Mailing Address - Country:US
Mailing Address - Phone:928-322-9652
Mailing Address - Fax:
Practice Address - Street 1:1600 S 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4011
Practice Address - Country:US
Practice Address - Phone:928-348-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN207689163WF0300X, 163WI0500X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WF0300XNursing Service ProvidersRegistered NurseFlight
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy