Provider Demographics
NPI:1700485174
Name:KYLE-STEPHENS, PAULA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:KYLE-STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9580 WESTENBARGER DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-8553
Mailing Address - Country:US
Mailing Address - Phone:740-501-1193
Mailing Address - Fax:
Practice Address - Street 1:9580 WESTENBARGER DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-8553
Practice Address - Country:US
Practice Address - Phone:740-501-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker