Provider Demographics
NPI:1952787772
Name:HARRIS, KYLIE LEWIS (AUD)
Entity type:Individual
Prefix:DR
First Name:KYLIE
Middle Name:LEWIS
Last Name:HARRIS
Suffix:
Gender:
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 W MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1345
Mailing Address - Country:US
Mailing Address - Phone:334-333-2832
Mailing Address - Fax:334-699-5175
Practice Address - Street 1:1733 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1345
Practice Address - Country:US
Practice Address - Phone:334-333-2832
Practice Address - Fax:334-699-5175
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA4013231H00000X
LA7860231H00000X
AL1355A231H00000X
NDH-0362235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL347776Medicaid