Individual
EDGAR M. KYLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
5124 FALCON RIDGE RD, ROANOKE, VA 24018-8621
(540) 353-6520
Mailing address
5124 FALCON RIDGE RD, ROANOKE, VA 24018-8621
(540) 353-6520
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0810000932
VA
103TC0700X
Clinical Psychologist
0810000932
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007705506
—
VA
05
—
007710682
—
VA
01
—
142969
BCBS OF VIRGINIA
VA
01
—
395223
BCBS OF VIRGINIA
VA
Enumeration date
06/26/2006
Last updated
03/04/2009
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