Individual
MR. KYLE R NILSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.S.
Contact information
Practice address
2068 EVELYN AVE, MEMPHIS, TN 38104-5416
(901) 308-4762
Mailing address
2068 EVELYN AVE, MEMPHIS, TN 38104-5416
(901) 308-4762
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/27/2017
Last updated
10/27/2017
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