1548315641 NPI number — PEARLENE MARIE KYLES-HARVEY MSW

Table of content: PEARLENE MARIE KYLES-HARVEY MSW (NPI 1548315641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548315641 NPI number — PEARLENE MARIE KYLES-HARVEY MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KYLES-HARVEY
Provider First Name:
PEARLENE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548315641
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 LAKE AVE
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46805-5397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-385-0713
Provider Business Mailing Address Fax Number:
260-422-8783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 LAKE AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
FORT WAYNE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46805-5397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-385-0713
Provider Business Practice Location Address Fax Number:
260-422-8783
Provider Enumeration Date:
01/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)