Individual
KYLE M SHADLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1708 COIT RD, SUITE 220A, PLANO, TX 75075-5024
(972) 596-6400
(972) 867-4766
Mailing address
1708 COIT RD, SUITE 220A, PLANO, TX 75075-5024
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
710328
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ARNP9186616
FL CRNA LICENSE
FL
01
—
G3766
BCBS OF FL #
FL
Enumeration date
09/26/2006
Last updated
01/16/2013
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