Provider Demographics
NPI:1174994453
Name:MASKELL, KYLE VINCENT (RN, AGANCP-BC)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:VINCENT
Last Name:MASKELL
Suffix:
Gender:M
Credentials:RN, AGANCP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-3624
Mailing Address - Country:US
Mailing Address - Phone:432-528-8360
Mailing Address - Fax:
Practice Address - Street 1:113 LAVENDER LN
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-3624
Practice Address - Country:US
Practice Address - Phone:432-528-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129287363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care