Provider Demographics
NPI:1811643521
Name:HOLSTED, KYLIE
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:HOLSTED
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 1:620 N MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4302
Mailing Address - Country:US
Mailing Address - Phone:469-752-7035
Mailing Address - Fax:
Practice Address - Street 1:620 N MURPHY RD
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4302
Practice Address - Country:US
Practice Address - Phone:469-752-7035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist