Provider Demographics
NPI:1164506622
Name:SCHMITT, KYLON A (PA-C)
Entity Type:Individual
Prefix:
First Name:KYLON
Middle Name:A
Last Name:SCHMITT
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 1:3770 8TH ST SW STE B
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1048
Mailing Address - Country:US
Mailing Address - Phone:515-270-1000
Mailing Address - Fax:515-967-5581
Practice Address - Street 1:3770 8TH ST SW STE B
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009
Practice Address - Country:US
Practice Address - Phone:515-270-1000
Practice Address - Fax:515-967-5581
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000747363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA000747OtherIOWA LICENSE
IA061473Medicare PIN