Provider Demographics
NPI:1558163857
Name:WILKINS, KYLE EVERETT (CIT)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:EVERETT
Last Name:WILKINS
Suffix:
Gender:
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 MOSER DR
Mailing Address - Street 2:
Mailing Address - City:BALL
Mailing Address - State:LA
Mailing Address - Zip Code:71405-3669
Mailing Address - Country:US
Mailing Address - Phone:318-625-9677
Mailing Address - Fax:
Practice Address - Street 1:210 LAUREL ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4662
Practice Address - Country:US
Practice Address - Phone:318-619-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)