Active NPI
Kylie Amber Wyldbore
- Peer Specialist
- Santa Cruz, CA
National Provider Identifier
1194509745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- MPSS-PGWUZT
- Practice address
- 1201 Shaffer Rd.
BLDG 1 Suite 1a
Santa Cruz, CA 95060 - Phone
- (831) 888-6234
- NPI assigned
- Aug 23, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | MPSS-PGWUZT | CA | Primary |
Addresses
Primary practice location
1201 Shaffer Rd.
BLDG 1 Suite 1a
Santa Cruz, CA 95060
Mailing address
1201 Shaffer Rd.
BLDG 1 Suite 1a
Santa Cruz, CA 95060
Phone (831) 888-6234
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 |
|---|---|---|---|
| MPSS-PGWUZT | CA | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692748800000",
"number": "1194509745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 SHAFFER RD.",
"address_2": "BLDG 1 SUITE 1A",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "95060",
"telephone_number": "831-888-6234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 SHAFFER RD.",
"address_2": "BLDG 1 SUITE 1A",
"city": "SANTA CRUZ",
"state": "CA",
"postal_code": "95060",
"telephone_number": "831-888-6234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYLDBORE",
"first_name": "KYLIE",
"middle_name": "AMBER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-23",
"last_updated": "2023-08-23",
"certification_date": "2023-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "CA",
"license": "MPSS-PGWUZT",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Cruz, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.