Provider Demographics
NPI:1164503264
Name:HYDE, KENNETH E (PA-C)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:HYDE
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:9040 REID ST # A
Mailing Address - Street 2:ATTN: CREDENTIALS)
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98431-5037
Mailing Address - Country:US
Mailing Address - Phone:253-968-1250
Mailing Address - Fax:253-968-2550
Practice Address - Street 1:9040 REID ST # A
Practice Address - Street 2:ATTN: CREDENTIALS)
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98431-5037
Practice Address - Country:US
Practice Address - Phone:253-968-1250
Practice Address - Fax:253-968-2550
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-11-30
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical