Provider Demographics
NPI:1215180021
Name:CARDON, KYLENE N (PA-C)
Entity Type:Individual
Prefix:
First Name:KYLENE
Middle Name:N
Last Name:CARDON
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 1:803 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-2383
Mailing Address - Country:US
Mailing Address - Phone:509-837-3933
Mailing Address - Fax:509-837-3885
Practice Address - Street 1:803 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2383
Practice Address - Country:US
Practice Address - Phone:509-837-3933
Practice Address - Fax:509-837-3885
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60051561363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant