Provider Demographics
NPI:1629627625
Name:OGLE, KYLE LESTER (AGNP)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:LESTER
Last Name:OGLE
Suffix:
Gender:M
Credentials:AGNP
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Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-3577
Mailing Address - Fax:314-884-6004
Practice Address - Street 1:12634 OLIVE BLVD
Practice Address - Street 2:DEPT NEUROLOGICAL SURGERY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6337
Practice Address - Country:US
Practice Address - Phone:314-362-3577
Practice Address - Fax:314-884-6004
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2025-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2019028557363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420078797Medicaid