Provider Demographics
NPI:1538953609
Name:DAVIDSON, KYLIE ERIN
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:ERIN
Last Name:DAVIDSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 SEASPRAY AVE
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-4108
Mailing Address - Country:US
Mailing Address - Phone:414-232-7761
Mailing Address - Fax:
Practice Address - Street 1:50 COCOANUT ROW STE 100
Practice Address - Street 2:
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480-4027
Practice Address - Country:US
Practice Address - Phone:561-200-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11038061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty