Provider Demographics
NPI:1033995485
Name:KYLE, KATHRYN DUSEK (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DUSEK
Last Name:KYLE
Suffix:
Gender:F
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 1:2808 GETTYSBURG DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-7530
Mailing Address - Country:US
Mailing Address - Phone:512-415-7066
Mailing Address - Fax:
Practice Address - Street 1:2808 GETTYSBURG DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-7530
Practice Address - Country:US
Practice Address - Phone:512-415-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant