Provider Demographics
NPI:1649651126
Name:SUMMERS, KILEY
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:SUMMERS
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 1:25206 HAMDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-7258
Mailing Address - Country:US
Mailing Address - Phone:314-910-0967
Mailing Address - Fax:
Practice Address - Street 1:25206 HAMDEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-7258
Practice Address - Country:US
Practice Address - Phone:314-910-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide