Provider Demographics
NPI:1750109666
Name:THOMPSON, KYLEE
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:THOMPSON
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 1:106 MULLER HILL RD
Mailing Address - Street 2:
Mailing Address - City:ZELIENOPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063-3706
Mailing Address - Country:US
Mailing Address - Phone:724-630-6688
Mailing Address - Fax:
Practice Address - Street 1:11279 PERRY HWY STE 204
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9303
Practice Address - Country:US
Practice Address - Phone:724-933-3912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health