Active NPI
Betty Wanda Kyle
- Nurse's Aide
- Conyers, GA
National Provider Identifier
1083957716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- CNA CERTIFICATION
- Practice address
- 1180 Christian Cir SE
Conyers, GA 30013-5823 - Phone
- (770) 679-6245
- NPI assigned
- Apr 1, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | CNA CERTIFICATION | GA | Primary |
Addresses
Primary practice location
1180 Christian Cir SE
Conyers, GA 30013-5823
Mailing address
1180 Christian Cir SE
Conyers, GA 30013-5823
Phone (770) 679-6245
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 |
|---|---|---|---|
| CNA CERTIFICATION | GA | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364774400000",
"number": "1083957716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1180 CHRISTIAN CIR SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300135823",
"telephone_number": "770-679-6245",
"fax_number": "770-602-1723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1180 CHRISTIAN CIR SE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300135823",
"telephone_number": "770-679-6245"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KYLE",
"first_name": "BETTY",
"middle_name": "WANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-04-01",
"last_updated": "2013-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "GA",
"license": "CNA CERTIFICATION",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conyers, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.