Provider Demographics
NPI:1295264901
Name:MOWRY, KYLE ANDREW
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ANDREW
Last Name:MOWRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-5870
Mailing Address - Country:US
Mailing Address - Phone:818-939-6482
Mailing Address - Fax:
Practice Address - Street 1:304 S 22ND ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-4726
Practice Address - Country:US
Practice Address - Phone:254-298-7130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator