Active NPI
Kyle Eugene Clyde, LMP
- Specialist
- Edgewood, WA
National Provider Identifier
1003032434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA00015312
- Practice address
- 2809 Meridian E.
Edgewood, WA 98371 - Phone
- (253) 840-1100
- Fax
- (253) 840-1199
- NPI assigned
- Apr 17, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA00015312 | WA | Primary |
Addresses
Primary practice location
2809 Meridian E.
Edgewood, WA 98371
Mailing address
2809 Meridian E.
Edgewood, WA 98371
Phone (253) 840-1100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA00015312 | WA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003032434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2809 MERIDIAN E.",
"city": "EDGEWOOD",
"state": "WA",
"postal_code": "98371",
"telephone_number": "253-840-1100",
"fax_number": "253-840-1199"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2809 MERIDIAN E.",
"city": "EDGEWOOD",
"state": "WA",
"postal_code": "98371",
"telephone_number": "253-840-1100",
"fax_number": "253-840-1199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLYDE",
"first_name": "KYLE",
"middle_name": "EUGENE",
"name_prefix": "Mr.",
"credential": "LMP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA00015312",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edgewood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.