Provider Demographics
NPI:1003989799
Name:KYER, MATTHEW EARL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:EARL
Last Name:KYER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3468
Practice Address - Street 1:200 HERLONG AVE S STE A
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1182
Practice Address - Country:US
Practice Address - Phone:803-328-1864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1262363A00000X, 363AM0700X
NC363AS0400X
NC0010-00694363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003989799Medicaid
SC15090PAMedicaid
NC8103109Medicaid
NCNCB676FMedicare PIN
NCNCB676AMedicare PIN
NCNCB676GMedicare PIN
NCNCB676BMedicare PIN
NCNCB676DMedicare PIN
SC15090PAMedicaid
SCSC06157772Medicare PIN
NC1003989799Medicaid
NCNCB676HMedicare PIN