Provider Demographics
NPI:1073815700
Name:KYLE, ALEXA NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ALEXA
Middle Name:NICOLE
Last Name:KYLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:NICOLE
Other - Last Name:MORGESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:45 READE PL
Mailing Address - Street 2:DYSON CANCER CENTER-DIVISION OF BREAST SURGERY
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3947
Mailing Address - Country:US
Mailing Address - Phone:845-483-6500
Mailing Address - Fax:845-483-6504
Practice Address - Street 1:45 READE PLACE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-483-6500
Practice Address - Fax:845-483-6504
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014548363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03448973Medicaid
NY03448973Medicaid