Provider Demographics
NPI:1164222725
Name:STALLARD, KYLEE ELIZABETH
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:ELIZABETH
Last Name:STALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 EDD MABE RD
Mailing Address - Street 2:
Mailing Address - City:LAWSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27022-7606
Mailing Address - Country:US
Mailing Address - Phone:336-712-7977
Mailing Address - Fax:
Practice Address - Street 1:1224 EDD MABE RD
Practice Address - Street 2:
Practice Address - City:LAWSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27022-7606
Practice Address - Country:US
Practice Address - Phone:336-712-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician