Provider Demographics
NPI:1780447383
Name:MANNING, KYLEE JACE
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:JACE
Last Name:MANNING
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 1:1828 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-8132
Mailing Address - Country:US
Mailing Address - Phone:405-308-8502
Mailing Address - Fax:
Practice Address - Street 1:1828 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-8132
Practice Address - Country:US
Practice Address - Phone:405-308-8502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist