Provider Demographics
NPI:1447045778
Name:NORMAN, KYLE RENEE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:RENEE
Last Name:NORMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KYLE
Other - Middle Name:RENEE
Other - Last Name:RUNYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3225 CALIFORNIA RD
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-8301
Mailing Address - Country:US
Mailing Address - Phone:757-752-4660
Mailing Address - Fax:
Practice Address - Street 1:3225 CALIFORNIA RD
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-8301
Practice Address - Country:US
Practice Address - Phone:757-752-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator