Provider Demographics
NPI:1841815743
Name:MARSHALL, KYLIE SUE (RN)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:SUE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:JOSEPHINE
Mailing Address - State:TX
Mailing Address - Zip Code:75173-7045
Mailing Address - Country:US
Mailing Address - Phone:702-332-8709
Mailing Address - Fax:
Practice Address - Street 1:1255 W 15TH ST STE 1025
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7253
Practice Address - Country:US
Practice Address - Phone:972-673-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX840399163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse