Provider Demographics
NPI:1235820747
Name:KYLE, DAVID THAYER (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:THAYER
Last Name:KYLE
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 1:7111 S VIRGINIA ST STE D2
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1141
Mailing Address - Country:US
Mailing Address - Phone:775-870-1230
Mailing Address - Fax:833-606-1557
Practice Address - Street 1:7111 S VIRGINIA ST STE D2
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1141
Practice Address - Country:US
Practice Address - Phone:775-870-1230
Practice Address - Fax:833-606-1557
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2869363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant