Provider Demographics
NPI:1639581960
Name:MORRIS, KYLIE L (DO)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:L
Last Name:MORRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E MAIN ST # 320B
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3267
Mailing Address - Country:US
Mailing Address - Phone:814-368-1000
Mailing Address - Fax:814-368-1008
Practice Address - Street 1:1001 E MAIN ST # 320B
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3267
Practice Address - Country:US
Practice Address - Phone:814-368-1000
Practice Address - Fax:814-368-1008
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS020843207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201231240Medicaid