Kyle Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME83612 Issued in FL

Legal business name

KYLE CLINIC

Practice address

1110 A1A N Ste 101
Ponte Vedra Beach, FL 32082-4071

Phone

(904) 280-8657

Fax

(904) 280-8659

NPI assigned

Dec 8, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacy Lawrence

Title

Office Manager

Phone

(904) 280-8657

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811056310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 A1A N STE 101",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320824071",
            "telephone_number": "904-280-8657",
            "fax_number": "904-280-8659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 A1A N STE 101",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320824071",
            "telephone_number": "904-280-8657",
            "fax_number": "904-280-8659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KYLE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "904-280-8657"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME83612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lawrence Owen Kollenberg, R.PH
• Kristin Koren
• Melissa Kotziers, PA-C
• Megan Leanne Krantz, PHD
• Macy Kwakenat
• Paxton-Ouellette B La Forge, AU.D.
• Lady Spearhead, LLC
• Andrea Lynne Lagnese, D.C.
• Marlene Kay Lamp, M.D.
• Mariah Lane, BCBA

• Family Medicine Physician in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.