Provider Demographics
NPI:1740026574
Name:SCHOULTIES, DYLAN SCOTT
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:SCOTT
Last Name:SCHOULTIES
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 1:44 WOODLAND HILLS DR STE 7
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2952
Mailing Address - Country:US
Mailing Address - Phone:859-630-8378
Mailing Address - Fax:
Practice Address - Street 1:1 LOUIE B NUNN DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41099-2952
Practice Address - Country:US
Practice Address - Phone:859-630-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program