Provider Demographics
NPI:1982947081
Name:AUSTIN, KYLIE JAREE (RDH, MS, ECP-II)
Entity Type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:JAREE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:RDH, MS, ECP-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 DONNAS WAY CIR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-7514
Mailing Address - Country:US
Mailing Address - Phone:785-672-7142
Mailing Address - Fax:785-587-2810
Practice Address - Street 1:407 ASH ST
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1713
Practice Address - Country:US
Practice Address - Phone:785-456-7872
Practice Address - Fax:785-456-1651
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10979124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist