Provider Demographics
NPI:1750901864
Name:OSWALT, KYLE DONOVAN (HCA)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:DONOVAN
Last Name:OSWALT
Suffix:
Gender:M
Credentials:HCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 83RD AVE SW APT A1
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-6064
Mailing Address - Country:US
Mailing Address - Phone:253-282-4557
Mailing Address - Fax:
Practice Address - Street 1:8101 83RD AVE SW APT A1
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-6064
Practice Address - Country:US
Practice Address - Phone:253-282-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide