Kylie Rachelle Coley

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2202008731 Issued in VA

Practice address

12001 Tygart Lake Dr
Bristow, VA 20136-6120

Phone

(703) 257-0356

NPI assigned

Jul 25, 2012

Last updated

Aug 27, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1343174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566864000000",
    "number": "1942556170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12001 TYGART LAKE DR",
            "city": "BRISTOW",
            "state": "VA",
            "postal_code": "201366120",
            "telephone_number": "703-257-0356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12001 TYGART LAKE DR",
            "city": "BRISTOW",
            "state": "VA",
            "postal_code": "201366120",
            "telephone_number": "703-257-0356"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1617 Park Place Ave",
            "address_2": "SUITE 110",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761101300",
            "country_code": "US",
            "telephone_number": "817-921-5020",
            "fax_number": "817-789-6849",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10600 Kettle Run Rd",
            "address_purpose": "LOCATION",
            "city": "Nokesville",
            "state": "VA",
            "postal_code": "201811727",
            "country_code": "US",
            "telephone_number": "703-594-3990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLEY",
        "first_name": "KYLIE",
        "middle_name": "RACHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-25",
        "last_updated": "2019-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "107993",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202008731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Christopher, QMHP-T, IAYT
• Patricia Cisnero, MS, LPC
• Katelyn E Clark, LPC
• Patricia Clubb, O.D.
• Paul T Colbourne, O.D.
• Chaz Taylor Collins, DMD
• Carlos Joel Contreras, PT, DPT
• Core Transportation, LLC
• Corevita Medical Equipment LLC
• Corner Piece LLC

• Speech-Language Pathologist in Bristow, VA
• Providers in Bristow, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; 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.