Individual
KYLEE SLADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
415 N 26TH ST, LAFAYETTE, IN 47904-2895
(765) 404-3055
Mailing address
415 N 26TH ST, LAFAYETTE, IN 47904-2895
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
28220955A
IN
Other
Enumeration date
08/03/2020
Last updated
03/31/2021
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