Provider Demographics
NPI:1083486534
Name:KOFLER, KYLIE JENNIFER (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KYLIE
Middle Name:JENNIFER
Last Name:KOFLER
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 1:3022 NEWFIELDS PL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-3481
Mailing Address - Country:US
Mailing Address - Phone:760-504-3554
Mailing Address - Fax:
Practice Address - Street 1:1010 HIGH HOUSE RD STE 202
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3576
Practice Address - Country:US
Practice Address - Phone:919-388-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13739363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant